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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 213-214

Intubating supraglottic airway device as a possible intubation tool in patients with COVID-19


1 Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India

Date of Submission12-Jun-2021
Date of Acceptance25-Aug-2021
Date of Web Publication04-Oct-2021

Correspondence Address:
Prof. Manpreet Singh
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/arwy.arwy_34_21

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How to cite this article:
Srinivasan AK, Singh M. Intubating supraglottic airway device as a possible intubation tool in patients with COVID-19. Airway 2021;4:213-4

How to cite this URL:
Srinivasan AK, Singh M. Intubating supraglottic airway device as a possible intubation tool in patients with COVID-19. Airway [serial online] 2021 [cited 2022 Aug 11];4:213-4. Available from: https://www.arwy.org/text.asp?2021/4/3/213/327513



The maintenance of an adequate airway and functional respiration is the fundamental responsibility of anaesthesiologists during the conduct of anaesthesia. Although there are many ways to secure the airway, endotracheal intubation is the gold standard and still one of the most important skills in anaesthesia.[1] We are battling with COVID-19 disease and airway handling in such patients exposes us to the risk of acquiring the virus as endotracheal intubation is an aerosol-generating procedure. The intubate COVID study reported that approximately 10% of those involved in tracheal intubation of patients with confirmed or suspected COVID-19 subsequently developed symptoms consistent with SARS-CoV-2 infection or a positive antigen test.[2]

Several bodies across the globe issued airway management guidelines, but a universal consensus is still lacking, possibly due to the novelty of the disease. However, laryngoscopy is still believed to be the most definitive way of securing the airway. Although innovations designed to avoid aerosol contamination such as the intubation box or transparent sheets have been designed as barriers, their practical use is still not a standard practice. The Difficult Airway Society guidelines, All India Difficult Airway Association guidelines and Consensus UK COVID-19 airway management guidelines advocate videolaryngoscopy as the default technique for tracheal intubation.[3],[4]

Several clinical studies have confirmed the efficacy of Fastrach™ laryngeal mask airway (LMA) as a conduit for tracheal intubation with a success rate >95%.[5],[6],[7] Furthermore, the use of supraglottic airway device (SAD), especially a second-generation device, has been incorporated into various guidelines as a rescue when endotracheal intubation fails.[3],[4] Although it has been observed in the literature that the LMA Fastrach™, a second-generation SAD, has higher success rates of blind intubation, other newer second-generation intubating SADs such as Ambu® AuraGain™, Intubating Laryngeal Tube Suction and AirQ® SP mandate use of a fibreoptic bronchoscope (FOB) for intubation. The need for FOB is the first prerequisite for using these newer second-generation SADs. The use of ILMA in COVID patients is still feasible regardless of whether FOB is available or not. The success rate of blind endotracheal intubation is very high and hence it is suggested that in COVID patients, even those who pose difficult airway, the trachea can be intubated blindly through LMA Fastrach™. This would circumvent the need to visualise the vocal cords and thereby prevent exposure to aerosol-containing viral particles.

However, the use of an SAD has its downside also. The choice of a properly fitting SAD is of paramount importance. Patients need to be breathing spontaneously to decrease aerosolisation which might not always be feasible. There is also a need to avoid positive pressure exceeding the airway seal pressure as this can lead to aerosol generation and dissemination. In conclusion, we believe that a second-generation SAD not only offers an alternative means to endotracheal intubation to secure the airway but could also prevent aerosol exposure in a select population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Janssens M, Hartstein G. Management of difficult intubation. Eur J Anaesthesiol 2001;18:3-12.  Back to cited text no. 1
    
2.
El-Boghdadly K, Wong DJ, Owen R, Neuman MD, Pocock S, Carlisle JB, et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: A prospective international multicentre cohort study. Anaesthesia 2020;75:1437-47.  Back to cited text no. 2
    
3.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785-99.  Back to cited text no. 3
    
4.
Patwa A, Shah A, Garg R, Divatia JV, Kundra P, Doctor JR, et al. All India Difficult Airway Association (AIDAA) Consensus guidelines for airway management in the operating room during the COVID-19 pandemic. Indian J Anaesth 2020;64:S107-15.  Back to cited text no. 4
    
5.
Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology 2001;95:1175-81.  Back to cited text no. 5
    
6.
Karim YM, Swanson DE. Comparison of blind tracheal intubation through the intubating laryngeal mask airway (LMA Fastrach™) and the Air-Q™. Anaesthesia 2011;66:185-90.  Back to cited text no. 6
    
7.
Badawi R, Mohamed NN, Abd Al-Haq MM. Tips and tricks to increase the success rate of blind tracheal intubation through the Air-Q™ versus the intubating laryngeal mask airway Fastrach™. Egypt J Anaesth 2014;30:59-65.  Back to cited text no. 7
    




 

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