Suction Assisted Supraglottic Airway Insertion by Dr Jim DuCanto

Brief note to accompany this post:

Supraglottic airway insertion can prove problematic in some cases due to limited mouth opening or large tongue relative to oral and pharyngeal cavity. In both cases, the path from lips to hypopharynx is restricted with regard to insertion of a SGA, potentially requiring the care giver to insert their fingers deeply into a patient’s mouth (not necessarily ok in patients not under general anesthesia), or to utilize a laryngoscope to place the SGA. The current post here demonstrates the use of a standard hospital issued Yankauer suction as a tool to open the airway in a patient with limited intraoral space, and furthermore, lift the base of tongue and epiglottis anteriorly to allow SGA insertion (most importantly) without the entrainment of the epiglottis into the ventilation channel of the SGA, something that occurs quite frequently in LMA type SGA’s, as they lack the epiglottis shielding bars of the LMA Unique/Classic. Use of a Yankauer as an insertion tool may be a useful maneuver in cases of difficult SGA insertion.

Here is a description of the technique:

1. Begin suctioning oropharynx with a Yankauer that is lightly lubricated with your standard airway-lubricant. Advance suction to base of tongue. Suction hose may be removed if the negative pressure impedes insertion into hypopharynx.
2. As the catheter rounds the base of tongue and likely enters esophagus, begin to lift the Yankauer in a manner identical to direct laryngoscopy. Focus on enhancing the intraoral space initially as the SGA is inserted in mouth and tip of SGA begins to round the base of tongue.
3. As the heel of the SGA (or pharyngeal balloon of Laryngeal Tube) begins to pass the base of tongue, concentrate on changing the lifting motion to open hypopharynx and lift epiglottis off posterior pharyngeal wall.
4. I recommend this maneuver be practiced in mannequins before it is used clinically. Be careful to not use force and scratch the inside of the pharynx or base of tongue.

Jim DuCanto, M.D.

Further comment from Dr Yen Chow here:
“I like that … in experienced hands that is very useful especially if there is lots of fluid in the airway already and say DL is not working. My only concern is that in inexperienced hands the significant risk of someone using too much force to cause soft tissue/soft palate/airway injury as we have seen such with the VL use of gliderite styletted ETT’s.”