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S E P T E M B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
Keeping an SGA in the edentulous patient.
Edentulous means lacking teeth. A common struggle for
anesthesia providers is placing an SGA in a patient with no
teeth and watching as it slowly migrates out onto the patient's chin.
Taping it down doesn't always work; the SGA tube slips from right to
left with little or no seal. When tape doesn't do the trick, try using the
commercial tube holder that respiratory uses in the ICU to hold endo-
tracheal tubes. This works in 2 ways. First, the device's Velcro wraps
around the head, so it's secure. Second, the actual tube holder C-
clamp will keep the SGA tube in the center of the patient's mouth,
encouraging correct seating and much less leaking.
Keeping the tongue
out of the way during insertion.
I've watched many students and providers struggle to place
an SGA in the patient with an uncooperative tongue. Either the tongue
folds over itself or slips from one side or another, stopping the SGA
from seating correctly. To solve this dilemma, I use a basic tongue
depressor to hold the rebel tongue in place as I slip the SGA into posi-
tion.
Stopping the tip of
an SGA from flipping.
One of the most frustrating events for providers is when you
cannot 'seat' an SGA because the tip of the SGA flips backwards dur-
ing insertion, resulting in a non-existent seal. One of the best ways to
avoid this from happening is to not deflate the SGA at all before inser-
tion. Simply take it out of the package and insert it as is, using the
tongue depressor. The amount of air in the SGA is enough to help stop
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D I F F I C U L T A I R W A Y S
