FLEXI-2G SAD is versatile – one supraglottic airway device that ticks all the boxes:
- Flexible Laryngeal Mask Airway
- 2nd generation Laryngeal Mask Airway-single use
- Improved pharyngeal seal - improved ventilation pressures
- Posterior inflatable cuff
- Improved gastric seal – reduced risk of aspiration
- Large volume #7 reinforced gastric drain tube
- Easy insertion and reduced risk of mal-positioning #7 reinforce drainage tube extends to oesophageal port
- Easy insertion of large bore nasogastric tube – drain tube ID 7mm
- Able to intubate through the Laryngeal Mask Airwaywith the use of an Aintree Intubating catheter
- Conforms to difficult airways where anatomically shaped rigid tubes fail
- Suitable for paediatric use
- Suitable for use in prone position
POTENTIAL PROBLEMS WITH A 1ST GENERATION FLEXIBLE SAD
- difficult to insert-hard to manipulate into larynx with single flexible tube
- leakage with positive pressure ventilation
- risk of gastric insufflation and aspiration
ADVANTAGES OF A 2ND GENERATION FLEXIBLE SAD
- Data show that specific features of the 2nd Generation Laryngeal Mask Airway may reduce the risk of pulmonary aspiration compared with the 1st Generation Laryngeal Mask Airway
- This is primarily due to the addition of
– Improved pharyngeal seal enabling controlled ventilation at higher airway pressures
– Increased oesophageal seal, which lessens the likelihood of regurgitant fluids entering the pharynx and leading to aspiration
– A drain tube which lies over the top of the oesophagus when the Laryngeal Mask Airway is correctly positioned. This may be used to:
- Assist insertion
- Confirm correct device positioning
- Enable access to the stomach
- Alert the user to the presence of regurgitation
- Enable gastric contents to safely bypass the oropharynx and exit the patient
- Easier insertion having 2 reinforced tubes attached to the mask gives more stability and manoeuvrability and prevents the mask of the supra glottic airway device folding over resulting in mal-positioning on insertion.
WHAT IS NAP4?
NAP4 is the largest study of major complications of airway management ever performed.
A year-long national service evaluation, endorsed by all four Chief Medical Officers of the UK, collected data between September 2008 and August 2009.
THE NAP4 REPORT DEMONSTRATES THAT:
Among airway management devices (ETT-FM-Laryngeal Mask Airway) Laryngeal Mask Airways were associated with a lower reported incidence of major airway complications per million than other devices
Cases of death/brain damage reported to NAP4 were ETT 9.1/million; FM 6.5/million; Laryngeal Mask Airway 5.0/million
The majority of Laryngeal Mask Airway-related complications were aspiration
In all but one case (second generation device, non-inflatable cuff), aspiration via an Laryngeal Mask Airway occurred with a first-generation device
The NAP4 report1 made three key recommendations on the use of second generation Laryngeal Mask Airways:
NAP4 RECOMMENDATIONS:
- If tracheal intubation is not considered to be indicated but there is some (small) increased concern about regurgitation risk, a SECOND GENERATION SUPRAGLOTTIC AIRWAY is a more logical choice than a first generation one.
- In patients considered to be at low risk of aspiration who have other factors that mean that use of an Laryngeal Mask Airway is at the limits of normality (e.g. patient position, access to the airway, patient size) consideration should be given to use of a SECOND GENERATION Laryngeal Mask Airway.
- In view of the above recommendations, and the frequency of these circumstances, it is recommended that all hospitals have SECOND GENERATION Laryngeal Mask AirwayS available for both routine use and rescue airway management.
