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• W1483751243 abstract "Several methods have already been proposed for the insertion of supraglottic devices. A study in this issue of the Journal describes a technique involving the prior insertion of a bougie into the upper esophagus over which the drain tube of the ProSeal laryngeal mask airway (PLMA) can be guided. Compared with the use of the metal introducer provided by the manufacturer, this method—with the drain tube—provides better positioning of the PLMA. It is worth noting that the authors concluded that the bougie technique is better because it allows alignment of the tip of the drain tube and the esophageal opening in a more predictable manner, not because the insertion time is shorter or the performance as a ventilatory device is improved. In fact, the bougie technique requires more time, more steps, and the use of a laryngoscope. Many clinicians will argue that the insertion strategy suggested by the authors of this study and others before them unnecessarily complicates a technique considered both simple and effective; therefore, they will likely be reluctant to adopt the technique on a routine basis. This is a paradoxical situation since many anesthesiologists view the incorporation of technical changes designed to prevent pulmonary aspiration to supraglottic devices as a significant improvement. It is worth mentioning that developers of supraglottic airways have long been concerned about pulmonary aspiration and remain attentive to its prevention. The original laryngeal mask, now called Classic, is equipped with an inflatable cuff that is designed not only to provide an adequate airway seal, but also to obstruct the esophagus in order to reduce the risk of gastric contents reaching the laryngeal opening. Other devices also include an inflatable cuff (King-LT laryngeal tube) or feature components of various shapes and sizes (PAXpress, CobraPLA), all designed to occlude the upper esophagus. Another device, the SLIPA (Streamlined Liner of the Pharynx Airway), includes a reservoir designed to collect regurgitated gastric contents. In recent years, however, the most commonly observed tendency in the design of supraglottic airways is the incorporation of a lumen designed to drain secretions from the digestive tract. Some manufacturers achieved this by modifying the design of existing devices, thus resulting in the development of the PLMA, the Supreme laryngeal mask, or the King laryngeal tube (King LTS-D). Others developed new devices, for instance, the I-Gel or the EasyTube. This strong interest in supraglottic devices offering a separate lumen to the digestive tract even led some authors to assess the use of the venerable Combitube for routine airway management during anesthesia. What evidence or arguments led manufacturers to opt for the integration or addition of a drain tube on their devices? We note that the approach is largely theoretical. Indeed, it is difficult to demonstrate that supraglottic airways without access to the digestive tract are responsible for a significant increase in pulmonary aspiration episodes during general anesthesia. Studies involving large patient populations, including some performed in populations traditionally considered at risk, such as Cesarean delivery patients, do not suggest that these devices are associated with a high incidence of clinically significant episodes of aspiration. Other studies involving indirect measures, such as pharyngeal pH or the use of dye (methylene blue), show that the separation provided by supraglottic devices between the digestive tract and the airway is not perfect. On the other hand, we have known for a long time that P. Drolet, MD (&) Departement d’anesthesiologie, Hopital MaisonneuveRosemont, Universite de Montreal, 5415, boul. l’Assomption, Montreal, QC H1T 2M4, Canada e-mail: pdrolet@aei.ca" @default.
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• W1483751243 date "2009-08-27" @default.
• W1483751243 modified "2023-10-08" @default.
• W1483751243 title "Supraglottic airways and pulmonary aspiration: the role of the drain tube" @default.
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• W1483751243 doi "https://doi.org/10.1007/s12630-009-9156-0" @default.
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