FLEXI-2G SAD IS VERSATILE – ONE SUPRAGLOTTIC AIRWAY DEVICE THAT TICKS ALL THE BOXES:
- Flexible LMA
- 2nd generation LMA-single use
- Improved pharyngeal seal – improved ventilation pressures
- 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 LMA with 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 LMA may reduce the risk of pulmonary aspiration compared with the 1st Generation LMA
- 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 LMA is correctly positioned. This may be used to:
1. Assist insertion
2. Confirm correct device positioning
3. Enable access to the stomach
4. Alert the user to the presence of regurgitation
5. Enable gastric contents to safely bypass the oropharynx and exit the patient
6. 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-LMA) LMAs 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; LMA 5.0/million
The majority of LMA-related complications were aspiration
In all but one case (second generation device, non-inflatable cuff), aspiration via an LMA occurred with a first-generation device
The NAP4 report1 made three key recommendations on the use of second generation LMAs:
- 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 LMA 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 LMA.
- In view of the above recommendations, and the frequency of these circumstances, it is recommended that all hospitals have SECOND GENERATION LMAS available for both routine use and rescue airway management.
- Increased risk of aspiration: Prolonged bag-valve-mask ventilation, morbid obesity, second or third trimester pregnancy, patients who have not fasted before ventilation, upper gastrointestinal bleed
- Need for high airway pressures; poor pulmonary compliance, high airway resistance
- Suspected or known abnormalities in supraglottic anatomy
- The cuff inflation must be checked before use
- Place on a flat surface then deflate the mask cuff with a syringe
- Lubricate the back plate of the mask
- Make sure the patients head is in the “sniffing the morning air” position
- Insert the laryngeal mask along the hard and soft palate, guiding the mask through the natural bend in the airway until resistance is felt
- Create a seal by inflating the mask cuff and check the pressure
- Confirm the mask is placed correctly and the patient ventilation is adequate. (The suprasternal notch tap test or the “Brimacombe bounce” confirms the location of the tip in the oesophagus behind the cricoid cartilage.)
| Device Code | Device Name | Size |
| DF2GSAD20 | Flexi 2G SAD with Bite Block | 2.0 |
| DF2GSAD25 | 2.5 | |
| DF2GSAD30 | 3.0 | |
| DF2GSAD40 | 4.0 | |
| DF2GSAD50 | 5.0 |