Elective use of supraglottic airway devices for primary airway management in children with difficult airways

In the March 2014 issue of the British Journal of Anesthesia (BJA), the group from Chicago Children’s Hospital reported their experience using supraglottic devices (SGAs) for anesthesia maintenance in children with dysmorphic syndromes and known difficult airways. Over a four-year period (2009-2013) the authors report a success rate of using of 96% during 109 general anesthetics. SGAs are well known to be useful for initial airway management in this population of children, as either a rescue device or as a conduit to tracheal intubation. However, there isn’t much reported as to their efficacy when used for the entire anesthetic. This is also important because the December 2013 issue of Anesthesiology contained an article from the University of Michigan ‘big data’ group that showed a higher incidence of LMA failure when used for this purpose. But, in an editorial that I wrote that accompanied that paper, I pointed out that just because it may have a significantly higher incidence of failure in thousands of patients, it doesn’t mean that the SGA isn’t the best choice for airway maintenance for the duration of the anesthetic. This current paper from BJA confirms that when appropriate, an SGA can be a useful and effective device for maintenance during general anesthesia.

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