issues or arthritis prevent you from moving them into the traditional
"sniffing" position for SGA insertion, look for a device that allows for
neutral position insertion, adds Dr. Frederick.
5. Reinforced SGAs
If your facility performs a lot of ENT, dental or plastic surgery cases
around the face, consider a reinforced LMA, says Ms. Velocci.
Compared to a standard SGA, these are made up of "floppy" tubing
reinforced with a coil, letting them bend and move more easily. "When
you use the more rigid ones, you can't get it out of the surgeon's way
like you can with a reinforced LMA," she says.
Dr. Frederick notes that at her center, which does primarily plastics
cases, she uses this style of LMA for all procedures around the face
because it minimizes the risk of facial fires that could occur when using
a nasal cannula. It also helps protect the airway from blood that can
trickle down the nasopharyngeal wall, enter the glottis and cause laryn-
gospasm.
6. Difficult airways
Supraglottic airway devices are often a go-to tool for difficult airways
and hard-to-ventilate patients, says Dr. Frederick. Several devices now
also make it easier for providers to insert an endotracheal tube, if nec-
essary.
These SGAs may have a U-shaped hook on them and are typically
designed for quick insertion into the patient's airway, says Ms. Velocci.
Once in place, the provider can slip the ET tube through the device's
opening and then past the glottis. Many models now have design
enhancements such as elevation ramps that make placement of the ET
tube toward the laryngeal inlet even easier.
Because these can be a lifesaver by providing continuous ventilation
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