The use of the Ambu Aura-i SupraGlottic
airway in an iSGA-first rescue strategy

A560
ASA 2011

Søren B. Laursen, M.D. 1 ; Frank Samsøe Jensen, M.D. 2 ; Anette Kristiansen, C.R.N.A.; Nazarena Mazzaro, Ph.D.;
1 Private Hospital Arresødal, Copenhagen Denmark 2 Copenhagen University Hospital Gentofte, Copenhagen Denmark

Introduction
In the clinical scenario of can not intubate/can not ventilate(CICV) a technically easy and readily available method ofsecuring the airway is vital. The ability to rapidly intubate thetrachea through an insitu SGA has the advantage of allowing
ventilation before and during intubation attempts. Although
the use of an SGA for the purpose of elective or emergency
intubation is not new, most methods described in theliterature employ the placement of a variety of exchange
catheters through standard SGAs which were designed fornoninvasive ventilation only. There are also SGAs designed
for blind intubation; however the intubation rate achieved
is low4,5,6. We describe a method of elective or rescue
orotracheal intubation using the new Ambu Aura-i SGA(Ambu A/S Denmark) and the Ambu aScope (single use
flexible optical scope) to ensure correct placement of theorotracheal tube. We refer to this concept as an iSGA-firststrategy: in this strategy, the elective or emergent use of
an intubation-capable SGA allows the rapid conversion totracheal intubation if needed.

ResultsConclusion

The Ambu Aura-i was inserted at 1st attempt in 34 patients. In one

The Ambu Aura-i performed satisfactory both as a ventilatory device

case the SGA had to be replaced to a smaller size. Ease of insertion

and as a conduit for flexible scope aided intubation.

of the Aura-i was evaluated as “very easy” in 32 patients and “fairlyManagement of an unanticipated difficult airway by flexible opticaleasy” in 2 patients. The average Aura-i seal pressure was 25,2 cm H2O

guided intubation using an SGA as a conduit is attractive because it may(16 – 35 cm H2O). In the 21 patients who were intubated with the use

allow unhurried optical instrumentation of the airway with a minimalof the aScope, the POGO score was rated; 1/30, 1/70% and 19/100%

interruption of oxygenation and ventilation.

(table 1). Intubation was successful on the first attempt in all 21 patients.
Discussion
Failure of first airway approaches may lead to temporary hypoxemia.

POGO score
19 patients

Depending on the skill level of the clinician and availability of alternative
intubation devices, some of these hypoxemic events could be prolonged,
possibly leading to more severe hypoxemia and brain damage or death.
If hypoxemia during airway management is avoidable by modifying andimproving the airway management with an iSGA-first strategy, outcomesmight be significantly improved.

Methods
Thirty-five patients with no predictors of difficult intubation
nor ventilation, scheduled for elective surgery were included.
An Ambu Aura-i was used for maintenance of anaesthesia
management in all cases. For a subset of patients in whom
the clinician elected tracheal intubation, an Ambu aScopewith a pre-loaded tracheal tube was inserted through theAura-i and into the larynx. Data regarding insertion success,ease of insertion of the Aura-i, seal pressure, optical view
with the aScope, and success of intubation were collected.
Ease of insertion was scored on a 5 level scale (1 = veryeasy, 2= fairly easy, 3= difficult, 4= very difficult and 5= notpossible). Seal pressure was measured in cm H2O. A POGO
laryngeal view score1,2 was measured once the Ambu aScope
was placed at the SGA opening.

Blind intubation through an SGA is not always successful at 1stattempt4,5,6. Use of a flexible scope to facilitate intubation via an SGA
1 patient30

1 patient70

should improve first attempt success rates, especially for the less100experienced clinician7. Further studies on the iSGA-first strategy inunanticipated difficult airways are needed to evaluate the effectivenessTabel 1: Nine-teen patients scored 100% POGO, one 70% and one 30%of this airway procedure in that population.

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Aknowledgement: Ambu A/S (Denmark) provided the devices