Airway

CASE REPORT
Year
: 2022  |  Volume : 5  |  Issue : 1  |  Page : 57--60

Gnana laryngeal airway device – A case series of our experience at a tertiary care cancer hospital


Suparna Mitra, Debashis DebRoy, Joy Mitra, Jyotsna Goswami 
 Department of Anaesthesiology, Critical Care and Pain, Tata Medical Center, Kolkata, West Bengal, India

Correspondence Address:
Dr. Debashis DebRoy
Department of Anaesthesiology, Critical Care and Pain, Tata Medical Center, Newtown, Kolkata, West Bengal
India

Abstract

Gnana laryngeal airway (GLA) is a supraglottic airway device with capability of hypopharyngeal suctioning for removing oral secretions. It is easy to insert and is an effective means of airway management. We present a case series of 32 patients in whom GLA was used as a primary device to manage the airway after induction of general anaesthesia for breast surgeries, intracavitary application of brachytherapy and cystoscopy. The GLA was found to be easy to insert in a short time.



How to cite this article:
Mitra S, DebRoy D, Mitra J, Goswami J. Gnana laryngeal airway device – A case series of our experience at a tertiary care cancer hospital.Airway 2022;5:57-60


How to cite this URL:
Mitra S, DebRoy D, Mitra J, Goswami J. Gnana laryngeal airway device – A case series of our experience at a tertiary care cancer hospital. Airway [serial online] 2022 [cited 2022 Jun 29 ];5:57-60
Available from: https://www.arwy.org/text.asp?2022/5/1/57/341054


Full Text



 Introduction



The classic laryngeal mask airway (CLMA), introduced in 1988 by Dr Archibald Brain, is widely used for airway management to provide general anaesthesia for a variety of surgical procedures both in adults and children.[1],[2] These devices are also useful as an immediate life-saving measure in difficult or failed intubation.[3] Gnana laryngeal airway (GLA), introduced recently by Gnana Medical (Australia) Pty Ltd., is a novel supraglottic airway device (SAD) made of polyvinyl chloride and meant for single use [Figure 1]. Similar in design to the CLMA, the GLA has an additional suction port on the convex portion of the laryngeal mask that allows the oropharynx to be cleared of secretions.[4] We describe our experience with the use of the GLA in 32 patients who underwent breast surgeries, intracavitary application of brachytherapy and cystoscopy under general anaesthesia. Barring one study, not much is available in literature about the GLA.[4] The purpose of this case series is to elaborate the efficacy and safety of this novel SAD in terms of ease and time of insertion, number of attempts, oropharyngeal leaks, peak airway pressure, mean airway pressure and postoperative complications.{Figure 1}

 Case Report



The GLA was used in 32 patients who underwent various surgeries lasting < 2.5 h requiring general anaesthesia with controlled ventilation. As the GLA is a single use device, we used a new GLA on each occasion. We excluded patients with morbid obesity, anticipated difficult airway (as evidenced by modified Mallampati class IV, mouth opening < 2.5 cm, restricted temporomandibular joint movement and neck mobility), laparoscopic surgeries and history of reflux diseases. Data were collected prospectively after obtaining Institutional Waiver Number (EC/WV/TMC/26/21). In the operating room, electrocardiogram, noninvasive blood pressure, pulse oximeter and temperature monitors were attached and intravenous (IV) access was secured. An appropriate size GLA was identified according to body weight and prepared prior to insertion with cuff completely deflated and dorsal surface lubricated with water soluble jelly. After 3 min of preoxygenation, IV fentanyl 2 μg/kg, propofol 2 mg/kg and atracurium 0.5 mg/kg were administered. After ensuring adequate jaw relaxation, the GLA was placed by an anaesthesiologist with the experience of at least 10 successful insertions of GLA. The cuff was inflated (cuff pressure maintained below 60 cm H2O) and the device secured according to the manufacturer's recommendations.[4] If the jaw was not adequately relaxed or the patient moved during placement, further boluses of 10 mg propofol were given. If the GLA did not seat effectively, manipulations such as deep insertion or slight withdrawal of the device were performed. The placement of the GLA was confirmed by the presence of normal thoracoabdominal movement and a square-wave capnograph trace. If these manoeuvres failed after 3 attempts, an i-gel was inserted. The ease of insertion, time for insertion and number of attempts were noted. Insertion was termed 'Easy' if no manipulation was required during insertion and 'Difficult' when manipulation was needed. Anaesthesia was maintained with inhaled sevoflurane at 1 MAC (minimum alveolar concentration) in a 50:50 air-oxygen mixture and controlled ventilation with intermittent dose of intravenous atracurium 0.125 mg/kg. Oropharyngeal leak was determined by transiently stopping ventilation, closing the adjustable pressure limiting valve with a fresh gas flow of 3 L/min until the airway pressure reached a steady state (not allowing it to exceed 40 cm H2O). Peak airway pressure and mean airway pressure were also noted. Salivary secretions were measured by aspirating them through the suction port of the device. Postoperatively, we assessed for sore throat, cough, aspiration, blood on device after its removal or any other side effects until the discharge from the postoperative area.

Statistical analysis was performed using the Epi InfoTM 7.2.2.2 statistical package (2017) (Centers for Disease Control and Prevention, Atlanta, GA, USA). Descriptive statistical analysis was performed to calculate the means with standard deviations. Test of proportion was used to find the standard normal deviate (Z) to compare the difference of proportions. One-way analysis of variance followed by post hoc Tukey's test was performed with the help of critical difference at 5% and 1% level of significance to compare the mean values. P <0.05 was considered to be statistically significant.

Demographic parameters including age, weight, height and body mass index are listed in [Table 1]. Breast surgeries were more compared to other procedures [Table 2] and airway assessment revealed favourable airway in most cases [Table 3]. Insertion at first attempt was easy and successful in the majority of cases [Table 4]. Peak airway pressure at 5 min postinsertion and oropharyngeal leak pressure at 1 min were within normal range [Table 5].{Table 1}{Table 2}{Table 3}{Table 4}{Table 5}

Complications such as sore throat, blood on device, aspiration and cough after removal of device were few and statistically insignificant (P > 0.05) [Table 6].{Table 6}

The volume of secretion was > 3 mL (maximum 15 mL) in 5 out 32 patients [Table 7]. Secretions that collected in the proximal part of the cuff of the GLA were aspirated with a 10 mL syringe.{Table 7}

 Discussion



In our case series, we found that the GLA was easy to insert with minimal oropharyngeal leaks. The GLA has an added advantage of allowing suctioning of hypopharyngeal secretions and regurgitated materials, thereby protecting the airway against postremoval aspiration and attendant complications.[5],[6]

A potential risk of the first-generation SAD is incomplete mask seal which causes air leakage or insufflation of air into the stomach. Kapoor et al. found that the mean peak airway pressure 5 min postinsertion was 15.02 ± 2.38 cm H20.[4] In our study, the peak airway pressure and the mean airway pressure were comparable.

Kapoor et al. did a prospective observational study on GLA in which the SAD was successfully placed in the first attempt in 72% patients and was effortless in 64% patients. They also found that the ease of insertion gradually improved and the mean insertion time decreased from 28.7 ± 1.86 s to 14.2 ± 0.79 s as expertise improved.[4] However, in our study, we found a first attempt success of 96.9% and easy insertion in 90.6% patients. The mean insertion time was 23.03 ± 8.69 s. Kapoor et al. found the volume of oropharyngeal secretions ranged from 3 to 5 mL per patient. Our observation of a maximum volume of oropharyngeal secretions of 15 mL was probably due to the nonusage of antisialogogue.[4]

Our study has limitations in that we excluded patients with morbid obesity, anticipated difficult airway and laparoscopic surgeries. Thus, our results cannot be extrapolated to these groups of patients. The position of patients during surgery also differed, making it a confounding variable. We also did not use a fibrescope for confirming correct positioning of the GLA.

 Conclusion



The GLA is easy to insert and can be positioned without any significant oropharyngeal leak. The peak airway pressure was maintained within physiological range. There were minimal complications and minimal cases of malposition of the device. Thus, with attainable practice and familiarity with the device, it can be safely and rapidly inserted with satisfactory periglottic seal. In the era of second-generation SADs, actual clinical benefit of usage of the GLA in various subsets of patients needs to be confirmed with further controlled trials and larger sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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