1 1 4
O U T P A T 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 | N O V E M B E R 2 0 1 5
Finding the supraglottic air-
way (SGA) device that will
work the best for your facili-
ty really comes down to 2
questions, says anesthesiol-
ogist Carrie Frederick, MD, of
Cumberland, Maine.
• Who are your patients?
• What other situations
should you plan for?
"Most standard SGAs should work for the majority of your patients. Then, you should
keep 1 or 2 styles on hand for your difficult airway cart," says Dr. Frederick. "But, finding
the right device means looking at your caseload. Are your patients overweight? Then a
standard LMA probably won't give you enough pressure. Are they breathing on their
own? Then a low-pressure classic LMA may be sufficient."
Larger facilities that operate on a wider range of patients typically should have at least
3 to 5 different models on hand for their ORs, says Dr. Frederick. That could include a
high-pressure option for those who need ventilation; one that allows for neutral position
insertion; a device that facilitates easy ET tube insertion and a standard low-pressure
laryngeal mask for routine cases.
She says smaller facilities may only have 2 to 3 available, which might include one for
difficult airways and ET tube insertion, and a standard option for their most common
cases. Keep in mind that some models may meet several of your needs, like a high-pres-
sure SGA that facilitates ET tube insertion and has gastric access.
At Dr. Frederick's plastic surgery center, she looked at what she needed and decided on
2 types: a disposable LMA that's for patients who have already gone to sleep and are
having difficulty due to recurrent obstruction of their airway, and a flexible (reinforced)
LMA for face cases. "I then looked and saw that my patients were usually breathing on
CHALLENGING INTUBATIONS
Narrowing Your SGA Decision
