This document discusses various airway equipment used in anesthesia. It describes laryngeal mask airways (LMAs) such as the classic LMA, ProSeal LMA, LMA Supreme, i-Gel, and Streamlined Liner of the Pharynx Airway. It also discusses oropharyngeal airways, nasopharyngeal airways, and the LMA Fastrach. The document provides details on the characteristics, advantages, and disadvantages of these different airway devices and how they have evolved over generations with modifications to their design and materials. It also discusses uses of supraglottic airways for ventilation and intubation or as rescue devices in difficult airway situations.

1. AIRWAY EQUIPMENTS
University of Gondar
College of medicine and health science
department of anesthesia
Misganaw(MSc)
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2. AIRWAY EQUIPMENT TYPES
 Laryngeal mask airway (LMA)
 Oropharyngeal airways
 Nasopharyngeal airways
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3. supraglottis airway
 The LMA was conceived and designed by Dr. Archie Brain
in U.K. in 1981. Following prolonged research, it was released
in1988.
 Extraglottic airway devices (EADs) have revolutionized the field
of airway management.
 The invention of the laryngeal mask airway was a game changer,
and since then, there have been several innovations to improve the
EADs in design, functionality, safety and construction material.
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4. SUPRAGLOTTIC DEVICES
 These have ranged from changes in the shape of the
mask, number of cuffs and material used, like rubber,
polyvinylchloride and latex
 Phthalates, which were added to the construction material
in order to increase device flexibility, were later omitted
when this chemical was found to have serious adverse
reproductive outcomes
 Bridge between MV and endotracheal intubation
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5. CONT…
 To reduce the possibility of compromising the safety of the
patient, the Diffcult Airway Society (DAS) formed the
Airway Device Evaluation Project Team (ADEPT) to
strengthen the evidence base for airway equipment and
vet the new extraglottic devices
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6. CLASSIFICATION OF DEVICES
 There are several criteria for classifying the EADs based
on variations ranging from
 cuffed versus noncuffed,
 the number of cuffs,
 location of the distal end in relation to glottis,
 reusable versus disposable,
 protection against aspiration and chronological order
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7.  Devices such as (cLMA) and (PLMA) are cuffed, while i-gel
and Baska mask are examples of noncuffed devices,the
latter having the advantages of avoiding the problems
associated with cuff-related morbidity.
 The flip side is that they may be accompanied with
increased risks of leaks and associated problems.
 The cuffless devices could offer the advantage of being
magnetic resonance (MR) compatible
by obviating the ferromagnetic material in the pilot balloon
of the cuff inflation assembly
Cuffed versus noncuffed
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8. Location of the distal end in relation to glottis
Supraglottic devices seal around the glottic inlet and remain
superior to the larynx (eg, cLMA, PLMA and Ambu masks).
Retroglottic devices are laryngeal tubes that terminate in
the upper esophagus, remaining posterior to the glottis
(eg, Laryngeal Tube [LT] and Laryngeal Tube Suction II
[LTS-II]).
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9. SEALING MECHANISM: PERILARYNGEAL VERSUS
BASE OF TONGUE
Base-of-tongue sealers such as LT, LTS-II, Streamlined
Liner of the Pharynx Airway (SLIPA) and Cobra
Perilaryngeal Airway (Cobra PLA) are also known as
pharyngeal sealers.
The laryngeal mask airways (LMAs) seal in the
perilaryngeal area and is known as perilaryngeal sealers.
The cLMA, invented by Dr Archie IJBrain, was the first
perilaryngeal sealer
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10. Reusable versus disposable
Original EADs (cLMA, LTS) were manufactured as reusable
oequipment; however, disposable devices (eg, i-gel, Ambu
oAuraGain) now available are cheaper and easier to maintain
othan the reusable devices and preclude concerns about prion
odisease.
Disposable devices are of special importance in the
ofollowing situations: 1) field situations and
o2) prevention of disease transmission
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11. PROTECTION AGAINST ASPIRATION
 The addition of a gastric tube such as PLMA, i-gel and
devices with reservoir (eg, SLIPA) provides some protection
against aspiration. Higher oropharyngeal seal pressure
(OSP), the first seal and the hypopharyngeal seal, the second
seal are important safety factors for protection against
aspiration (eg,PLMA). The SLIPA has a different mechanism
separating respiratory and gastrointestinal tracts and allowing
storage
of gastric fluid, being a hollow liner of the pharynx under
pressure, thus providing a liquid trap within the device
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12. SUPRAGLOTTIC AIRWAY DEVICES – EVOLUTION
 First generation devices- simple airway tubes
Classic LMA
Flexible LMA
Cobra PLA
 Second generation – includes drainage tubes
ProSeal LMA
I-Gel
LMA Supreme
SLIPA
 Third generation - cuffless, two drain tubes, small bowl
Baska mask.
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13. CLASSIC LMA
Advantages
■ Increased speed and ease of placement
■ Improved hemodynamic stability
■ Reduced anesthetic requirements
■ Less coughing and sore throat
■ Can be done by inexperienced personnel
Disadvantages
■ Low pressure seal – increased risk
of gastric aspiration
■ Suction not possible
■ Tip may get folded causing
obstruction
■ Inadequate seal – PPV is difficult
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15. CLASSIC LMA VS PROSEAL LMA
Advantages
■ Separate gastric tube port - for gastric access, checking
correct
positioning
■ Dorsal cuff -provides better seal and higher sealing
pressures
■ With drain tube occluded – less incidence of gastric
aspiration
■ Bite block.
■ Can be used for both spontaneous and controlled
ventilation 15

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17. 17

18. CLASSIC LMA VS PROSEAL LMA
Brimacombe J, Keller C, Fullekrug B, et al. A multicenter study
comparing the ProSeal™ and Classic™ laryngeal mask
airway in anesthetized, nonparalyzed patients. Anesthesiology
2002;96: 289–95.
Disadvantages*
■ More incidence of trauma
■ Equivocal incidence of sore throat as compared to cLMA
■ Slightly longer insertion time compared to cLMA
■ 20% more airway resistance than classic airway in
spontaneously breathing patients.
■ Less suitable as an intubation device
■ Requires a greater depth of anesthesia for insertion
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20.  Modifications of LMA Supreme
1. Fixation Tab (FT) :
Facilitates easy insertion and fixation of the LMA
Visual guide to ‘correct’ size select - after inflation of
the cuff, the FT should be 1.5–2 cm from the upper lip
If distance is less, the size chosen may be too small
If >3.0 cm from the upper lip the size chosen may be
too large
Modifications of LMA Supreme
 2. Airway Tube:
Unique, flattened, firm, anatomically shaped airway tube -
elliptical in cross-section
Elliptical shape facilitates insertion in patients with
reduced interdental space, without increasing the
resistance to breathing
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21.  Firm, anatomical shape facilitates easy insertion without
placing fingers in the mouth
Helps to minimize accidental rotation, once in place
Lateral grooves on either side prevent kinking
Modifications of LMA Supreme
3. Drainage Tube:
Runs from its rigid proximal end, through the middle of
the airway tube, continues along the posterior surface of the
cuff
Equalizes the pressure between UES and atmosphere
Vents gastrointestinal gases and liquids
Serves as a conduit for the passage of nasogastric tube
Indicator of correct tube positioning 21

22. MODIFICATIONS OF LMA SUPREME
4. Cuff:
Modified and enlarged inflatable cuff
Enhances the anatomical fit into the pharynx
Glottic seal pressures between cLMA and ProSeal LMA
Moulded distal cuff - strengthens the tip and prevent it
from ‘folding over’ during insertion
Modified fins - prevent the epiglottis from becoming
wedged in the airway
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24.  LMA Fastrach
“Intubating Laryngeal Mask Airway”
Uses:
To facilitate tracheal intubation
Can also be used as a primary airway device
Rescue device for failed intubation
Blind or fiberscopic guided insertion
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25. LMA FASTRACH
 Disadvantages:
Pharyngeal pathology or limited mouth opening
Cannot be used for intubation in patients below
30 kg
Expensive & prolonged use is to be avoided
The tracheal tube may be displaced downward or
dislodged
Unsuitable for use in the MRI unit
Increased incidence of sore throat and difficulty
swallowing
Esophageal intubation
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It is a single-use preshaped
cuffless device

27. I-GEL
 Second generation supraglottic airway device – 2007
Mask made of medical grade thermoplastic elastomer -
Styrene Ethylene Butadiene Styrene (SEBS)
Adapts to patients airway - anatomical seal of the
pharyngeal, laryngeal and peri-laryngeal structures
Provides effective seal without a cuff
i-GEL
Soft, gel-like, non-inflatable cuff,designed to provide an
anatomical impression fit over the laryngeal inlet.
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28.  The shape, softness and contours
accurately mirror the peri-laryngeal anatomy - no cuff
inflation is required.
 Compression and displacement trauma are significantly
reduced or eliminated.
i-GEL
Firmness of material – facilitates easy insertion
Tip design – prevent folding back of tip edge
Epiglottic rest – prevents downfolding of epiglottis
Buccal stabilizer and broad mask – provides
stability, reduce kinking and midline positioning
Gastric channel – helps to vent gastric secretions
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29.  Greater airway seal pressures and superior fibreoptic
views as compared to other SGAs*
 Wide lumen allows for airway rescue and assisted
intubation
Effective in prone position ventilation
*Lisa S Razan N Narasimhan J, Update on Airway Devices
Curr Anesthesiol Rep. (2015) 5:147–155
Airway Rescue With i-Gel
i-Gel is established in emergency airway control.
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30.  Case reports are present where it has been used
for airway rescue
when cLMA and PLMA have failed
I-gel has been used for airway rescue in prone
position*
* Dingeman RS, Goumnerova LC, Goobie SM. The
use of a laryngeal mask airway for emergent airway
management in a prone child, Anest
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31. - STREAMLINED LINER OF THE PHARYNX AIRWAY
 ■ Plastic uncuffed disposable
■ Hollow boot shaped distal part
■ Anatomically fits pharynx
– Toe rests in esophageal entrance
–– Heel – anchors to soft palate
– Large size prevents aspiration of regurgitated fluid
Advantges
■ Better airway sealing pressures for PPV
■ Cuffless
 Epiglottic downfolding was reported to be signifcantly
lower with the SLIPA as compared to the PLMA in patients
undergoing lower abdominal laparoscopic surgery
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32. SLIPA
 Disadvantages
• More traumatic
• Occupies space upto soft palate.
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34. BASKA MASK
 3rd generation supraglottic airway device
Smaller bowl compared to other LMAs - less risk of
including oesophageal opening
Adjustable tab in shaft to increase angulation - allows
easy negotiation of oropharyngeal curve
Double gastric channel - one channel is open to air so
less chance of oesophageal wall impinging the gastric
opening during suction
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35.  Supraglottic Airway Guided ET Intubation and
Fibre Optic Laryngoscopy
 LMA Fastrach
LMA ProSeal
LMA Supreme
i-Gel
SLIPA
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36. GUEDEL’S OROPHARYNGEAL AIRWAY
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37. OROPHARYNGEAL AIRWAY
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38. OROPHARYNGEAL AIRWAYS

■ Uses –
1) To maintain open airway
2) Prevent endotracheal tube occlusion
3) Prevent tongue bite
4) Facilitate suction
5) Conduit for passing devices into oropharynx
6) Obtain a better mask fit
■ Contraindications –
1) Intact gag reflex
2) Oropharyngeal growth
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39. NASOPHARYNGEAL AIRWAY (NPA)
oAn airway adjunct
oRounded, curved body
oProximal flange
oUse with lubrican
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