Advances in supraglottic airway devices for the management of difficult airways in children

ABSTRACT

There are innumerable tools and devices available to facilitate airway management and life-saving gas exchange of the patient’s lungs. Over the years, various designs and generations of supraglottic airway devices have proven to be effective in accomplishing this function. Their application has grown beyond the original purpose of controlling the normal pediatric airway without tracheal intubation, and has been incorporated in the difficult airway management algorithms of anesthesia societies around the world based on clear evidence of efficacy. Older supraglottic airway devices since the 1980’s have been validated in multiple clinical trials to be safe and effective in the pediatric population, however there is also sufficient evidence that the newer designs have features that help overcome some limitations. These newer designs and features are effective in managing both the normal and difficult pediatric airway, and will be discussed in this comprehensive review.

KEYWORDS:

• Supraglottic airway device
• pediatrics
• difficult airway
• fiberoptic intubation
• airway management

Financial & competing interests disclosure

N Jagannathan is an unpaid consultant for Ambu & Mercury Medical; he is on the Medical Advisory board of Teleflex and has received travel support for meetings involving future developments for upcoming airway devices. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• SGA devices are safe and effective in children.

• They are incorporated in the difficult airway algorithm of anesthesia societies around the world.• SGA use is a distinct step in all airway algorithms when difficult mask ventilation and/or failed intubation is encountered.• SGAs can be used as an alternative to tracheal intubation.

• Older devices have limitations that newer SGA designs and features have attempted to overcome.

• Second-generation devices provide better airway seals, better fiber-optic views, and are more effective conduits for tracheal intubation.