Airway Educational Project

Medinfo Sites weblog
28
Feb


Oh, oh… what about aspiration and the use of SGA’s?

By •• Posted in Education, SGA

The anatomical proximity and shared structures between the respiratory and alimentary tracks, make sense -of course- for many of our evolved biological functions; but from the airway management point of view, it actually brings formidable challenges. The possibility of aspiration of gastric contents and pharyngeal secretions and blood, has been the focus of tremendous attention since the early days of our ability to instrument the airway. ┬áIs the use of SGA’s prohibitive for certain procedures or for patients that have controlled reflux disease? Or, better yet is endotracheal intubation always protective? If you are curious, read on…

Aspiration and Supraglottic Airways

Intubation Article

5 Responses to “Oh, oh… what about aspiration and the use of SGA’s?”

  1. Nikolaus Gravenstein says:
     

    this reminds us that regurgitation happens with all airway approaches. what is missing is how many patienst had low ph in their airway. others have done this sort of thing with some methylene blue in the stomach and then looked oti see if it gets into the trachea. as i recall it did with uncuffed tubes and i suspect it would with the slas in people with frank refulx. it is the history of frank reflux or not that should influence the decision to use a sla and always a caution to not inflate the stomach during intital airway support.

     
  2. Nikolaus Gravenstein says:
     

    this is an interesting study that never attracted much attention. wish they had repeated it with mechanical ventilation and a little peep. maybe a uf study to be done. the spontaneous ventilation clearly predisposes to aspiration of pharyngeal secretions and also reflux from the stomach thoug the latter was not studied.

     
  3. Felipe Urdaneta says:
     

    I think also it brings the point that is important to distinguish between regurgitation, aspiration and actually pneumonitis; although all three may present themselves, if there is overt aspiration, I guess we miss the lasttwo much more common phenomena, since we do not monitor for pH in the esophagus. Thanks for the feedback.

     
  4. Patrick Tighe says:
     

    A good point that Dr. Noble makes pertains to pressure gradients between the pharynx, esophagus and trachea. Your OSA population may not have GERD/reflux, until they’re obstructing! Significant negative pressures generated in the hypopharynx may then encourage reflux. Could you justify then using an early SGA to avoid upper airway obstruction during the transition period preceding intubation, thereby minimizing this effect?

    As far as the lubricant, what about non-water soluble agents? Messier, perhaps, but I’m not sure how long the water soluble agents will remain in situ.

     
  5. Felipe Urdaneta says:
     

    For your first point, some people actually recommend using an LMA as a bridge to extubation, for your second point I do see a future perhaps for “antibiotic coated ETT’s” similar to CVL’s… why not?

     

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