Discussion
supraglottic airway, airway damage, glottis, SAD
BLIND
In this study, we compared the effect of different insertion techniques on the oropharyngeal seal pressure of the laryngeal mask when using SaCoVLM™. The results showed that the oropharynx leak pressure was higher when the optimal glottic exposure was obtained by using up-down optimized glottic exposure manoeuvre. Although supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar ‘blind’ way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement [SaCoVLM™ combines the features of the second-generation SAD, long-term ventilation and visualization of the glottis. It has been shown that SaCoVLM™ can be used to maintain ventilation in patients under general anesthesia [In the present study, 13 (21%) patients demonstrated the same grade of glottic view either by the blind insertion manoeuvre or the up-down optimized glottic exposure manoeuvre, involving 4 cases with grade 2, 4 with grade 3 and 5 with grade 4. Therefore, we believed when using the traditional blind insertion technique of SAD can not immediately obtain an optimal exposure of the glottis, and a satisfactory OPLP. To avoid airway damage, an upper limit of 40 cmHThe camera of the SaCoVLM™ is located on the right side of the opening of the ventilation channel in the ventral cuff, which differs from the upper location of the LMA CTrach™ [The Difficult Airway Society (DAS) guidelines [