Module 14
Advanced Airway Techniques
Part 2 - New Generation Supraglottic Ventilatory Devices>
Desirable Features and Optimal Methods for Testing
ISSUES
Until the late 1980’s, the options for
maintaining the airway during anesthesia were largely limited to
the ET, or the facemask combined with an oropharyngeal airway.
The initial response was sceptical but despite this, many ‘gave
it a go’ and it was soon firmly established in anesthetic
practice. Since then the LMA (now called the LMA-ClassicTM,
cLMA) has been used in approximately 150 million anesthetics and
there are over 2400 studies published on the use of the device.
The market for supraglottic airways is
extensive. Recent surveys in three European Countries have
reported that the cLMA is used in approximately 65% of general
anesthetics. In the UK this represents 3.5 million uses each
year. At approximately $3 per use, this market costs in excess
of $12 million per year, in the UK. Of course, the UK
represents only a fraction of the global market.
There are five variations of the laryngeal
mask (classic, flexible, intubating, double-lumen and
disposable) and at least 10 other distinct supraglottic airways
currently on the market. Two more are in final development
(AMD, GPT- glossopharyngeal tube).
Two had been introduced and have now been
abandoned (COPA- cuffed oropharyngeal airway, The glottic
aperture airway (GO2; Augustine Medical, Inc., Eden
Praire, MN) actually never made it into clinical use.
Mallinckrodt, Hazelwood, MO; PAx - Pharyngeal Airway Express,
Vital Signs, Totowa, NJ).
The market for single-use devices is
increasing. There are five different manufacturers of single
use cLMAs (Ambu, Intavent Orthofix [probably LMA company for
North America], Intersurgical, Marshalls and Portex), at the
time of writing, and this is expected to increase to twelve
within a year. There are important design differences between
all five single use cLMAs. If all variants are included, there
are 19 supraglottic airways available for non-intubated patients
and nine more soon to be released. All but three of these
devices have been introduced to Europe in the last three years.
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