Supraglottic airways (SGAs) may work well for prone spinal procedures of short duration, according to a recent study. But others consider this a dangerous practice.
SGA use has been studied in the prone position but with limited patient numbers, varying weights and different levels of airway status. In this case, SGA use could help anesthesiologists and surgeons avoid intubation, reduce use of relaxants and minimize airway trauma. In addition, SGAs help promote stable hemodynamics and help maintain spontaneous ventilation.
“SGAs have been used in a variety of surgical procedures, yet rarely for prone cases,” said Thomas O’Connor, MD, of Kenmore Mercy Hospital, in Buffalo, N.Y. He presented his research at the 2016 annual meeting of the Society for Airway Management. “Few consider SGA use in prone cases, preferring endotracheal intubation.”
For this study, Dr. O’Connor and his colleagues collected data from 152 consecutive elective prone procedures. After induction with 3 mg/kg of propofol while supine, a laryngeal mask airway (LMA) was placed, and patients were turned prone with the LMA positioned downward. Anesthesia was maintained with sevoflurane and hydromorphone.
All patients fell into American Society of Anesthesiologists physical status I to III with an average age of 57 years and a body mass index of 30 kg/m2, and an even split between men and women. The average case duration was 57 minutes.
Of the procedures, 12% of patients required a minor adjustment of the LMA by turning the head to the side. This adjustment was not related to any recorded demographics, the researchers noted. About 4% of patients had secretions around the LMA shaft, and no aspirations occurred. In addition, no patients needed to be returned to the supine position for endotracheal intubation.
Indeed, Dr. O’Connor has managed about 1,200 of these cases in total, and only two patients have needed to be turned to the supine position for intubation. Nonetheless, Dr. O’Connor cited “Airway Management Roundtable: Seven Questions,” a review article from Anesthesiology News Airway Management(2016:9-24), which featured 10 experts who voiced near-unanimous disagreement with use of SGAs in prone procedures, calling it hazardous and, in the words of one participant, “daft.”
“Be selective in the use of this technique,” he warned. “I have the ability to work with one surgeon and wouldn’t do this with someone [with whom] I’m not familiar.
“I recognize that people feel this is inherently dangerous, but something has to be said for the technique,” he said. “I’m not recommending that people do this. I’m simply saying that this is what I’ve done, and it’s worked.”
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