Evaluation of the SLIPA™ (Streamlined Liner of the Pharynx Airway), a Single Use Supraglottic Airway Device, in 60 Anaesthetized Patients Undergoing Minor Surgical Procedures

Comparison of the third-generation streamlined liner of the pharynx airway (SLIPA-3G) with the laryngeal mask airway supreme for laparoscopic cholecystectomy: a randomized prospective study

Background

The third-generation streamlined liner of the pharynx airway (SLIPA-3G) is a new-generation supraglottic airway device (SAD) that is non-cuffed and disposable, with a sealing pressure that varies dynamically with the airway pressure. This study compared the SLIPA-3G with the laryngeal mask airway supreme (LMAS) in patients undergoing laparoscopic cholecystectomy.

Methods

Two hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly allocated to either the SLIPA-3G group or the LMAS group. Data were collected on the patients’ hemodynamic parameters at different time points, ease of insertion, fiberoptic view, oropharyngeal leak pressure (OLP) at different time points and SAD-related complications.

Results

The mean OLP immediately after device placement in the LMAS group was significantly higher than that of the SLIPA-3G group (31.34 ± 6.99 cmH₂O vs.28.94 ± 6.01 cmH₂O, P = 0.008, 95% CI 0.62–4.17). The OLPs of the two groups were not significantly different after the induction of a pneumoperitoneum until the end of surgery. The OLP increased gradually through the course of the operation in the SLIPA-3G group (P value = 0.035) but not in the LMAS group (P value = 0.945). There was no significant difference between the two groups in hemodynamic parameters, insertion time and success rate, fiberoptic view and complication rate.

Conclusions

The SLIPA-3G and LMAS were associated with comparable OLPs, hemodynamic parameters, ease of insertion, fiberoptic views and complication rates when used during laparoscopic cholecystectomy. The SLIPA-3G can be used as an effective alternative to the LMAS in patients undergoing laparoscopic surgeries.

A comparison of the effectiveness of the streamlined liner of pharyngeal airway in paralyzed and nonparalyzed patients undergoing gynecological surgery: a randomized trial

STUDY OBJECTIVE

To compare the effectiveness of streamlined liner of pharyngeal airway (SLIPA) in paralyzed and nonparalyzed, anesthetized patients undergoing gynecological surgery.

DESIGN

Prospective randomized double-blind clinical trial.

SETTING

Intraoperative.

PATIENTS

A total of 80 female patients with American Society of Anesthesiologists class I or II and who were undergoing gynecological surgery.

INTERVENTIONS

The patients were randomly allocated to either the nonparalyzed group (group NR, n=40) or the paralyzed group (group R, n=40).

MEASUREMENTS

Oropharyngeal leakage pressure was the primary outcome. Insertion time; number of insertion attempts; success rate at first insertion; involuntary movement; peak inspiratory pressure (PIP); leakage fraction; hemodynamic changes; complications, such as blood tinging, regurgitation, and sore throat; and recovery time were also evaluated for secondary outcomes.

MAIN RESULTS

Oropharyngeal leakage pressure, which is primary outcome, was no difference among the groups. Insertion time, number of insertion attempts, success rate at first insertion, involuntary movement, leakage fraction, hemodynamic changes, and complications were not statistically different among the groups. The PIP in group NR was significantly increased compared to that of group R (P=.002). Recovery time was significantly longer in group R than in group NR (P<.001).

CONCLUSIONS

SLIPA had good performance in both paralyzed and nonparalyzed patients. There was no difference in SLIPA performance or complications irrespective of muscle relaxant use, except decrease in PIP and prolong recovery time in paralyzed patients.

Gastric distension with SLIPA versus LMA ProSeal during laparoscopic cholecystectomy: a randomized trial

BACKGROUND

We compared the quantitative clinical performances of the streamlined liner of the pharynx airway (SLIPA) and the ProSeal laryngeal mask airway (LMA ProSeal) regarding intensity of gastric distension in patients undergoing laparoscopic cholecystectomy.

METHODS

A total of 124 anesthetized, paralyzed patients (ASA 1 to 2; aged, 18 to 80 y) were randomly allocated for airway management with the SLIPA or LMA ProSeal. After induction of general anesthesia using total intravenous anesthesia and rocuronium, the intensity of gastric distension was accessed twice by 2 raters, respectively. We also compared the fiberoptic bronchoscopic view of the glottis, the severity of blood stain, and postoperative sore throat.

RESULTS

There were no statistically significant differences between groups for each gastric size. The change of gastric size within the SLIPA group was not statistically significant for both raters. Change within the LMA ProSeal group was significant in rater 2 (P=0.045) and marginally significant for rater 1 (P=0.056). Anatomic fit, complications during emergence, and the severity of blood stain and postoperative sore throat were similar in both groups.

CONCLUSIONS

SLIPA is as efficacious as LMA ProSeal for use in patients without severe complications who are undergoing laparoscopic cholecystectomy.

Extraglottic airway devices: A review

Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted.

Supraglottic airway devices in the ambulatory setting

Supraglottic airway devices (SGAs) offer certain advantages over endotracheal intubation, making them particularly well suited for the specific demands of outpatient anesthesia. Patients may tolerate the placement and maintenance of an SGA at a lower dose of anesthetic than that needed for an endotracheal tube; neuromuscular blocking agents are rarely necessary for airway management with an SGA; the incidence of airway morbidity is lower with SGAs than with endotracheal tubes; and SGAs may facilitate faster recovery and earlier discharge of patients. Two limitations of SGAs are incomplete protection against aspiration of gastric contents and inadequate delivery of positive pressure ventilation. Newer variants of the original laryngeal mask airway, the LMA Classic (LMA North America, Inc), as well as an array of other recently developed SGAs, aim to address these limitations. Their utility and safety in specific patient populations (eg, the morbidly obese) and during certain procedures (eg, laparoscopic surgery) remain to be determined.

A critique of elective pediatric supraglottic airway devices

In 1988, when the Laryngeal Mask Airway-Classic (Intavent Orthofix, Maidenhead, UK), was introduced there were only two choices of airway management: tracheal tube or facemask. The supraglottic airway, as we now understand the term, did not exist. Yet, 20 years later, we are faced with an ever increasing choice of supraglottic airway devices (SAD). For many SADs, with the exception of the LMA-Classic and LMA-Proseal (Intavent Orthofix, Maidenhead, UK), there is a lack of high quality data of efficacy. The best evidence requires a randomized controlled trial comparing a new device against an established alternative, properly powered to detect clinically relevant differences in clinically important outcomes. Such studies in children are very rare. Safety data is even harder to establish particularly for rare events such as aspiration. Therefore, most safety data comes from extended use rather than high quality evidence which inevitably biases against newer devices. For reason of these factors, claims of efficacy and particularly safety must be interpreted cautiously. This narrative review aims to present the evidence surrounding the use of currently available pediatric SADs in routine anesthetic practice.

Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

This article is intended as a generic guide to evidence-based airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommendations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated unsuccessful intubation attempts should be avoided independent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopulmonary resuscitation, we recommend that non-anaesthesiologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI.

Brief review: the Cobra Perilaryngeal Airway (CobraPLA and the Streamlined Liner of Pharyngeal Airway (SLIPA) supraglottic airways

PURPOSE

To summarize the published literature related to two, new supraglottic airways (SGAs): the Cobra Perilaryngeal Airway (CobraPLA) and the Streamlined Liner of Pharyngeal Airway (SLIPA).

SOURCE

We identified original articles, through searches on Medline and PubMed, using the keywords 'Cobra', 'CobraPLA', 'Cobra-PLA', 'PLA', and 'SLIPA'.

PRINCIPAL FINDINGS

Searches identified 28 publications evaluating the CobraPLA, six of which were randomized, controlled trials. Five publications evaluated the SLIPA, two of which were randomized, controlled trials. Studies compared the CobraPLA with a number of SGAs, in regards to both efficacy and safety. While the CobraPLA is comparable to the laryngeal mask airway (LMA) Classic, with respect to insertion times and the incidence and severity of sore throat, the CobraPLA is superior, with respect to airway sealing pressure, and has been used successfully in patients with limited mouth opening and limited head extension. Insertion times, first insertion success rates, recovery times, and hemodynamic responses, associated with insertion of the SLIPA, are similar to those of the LMA Proseal. Although the SLIPA has a unique reservoir chamber to contain regurgitated fluid, the extent of its protection against pulmonary aspiration has not been established in the clinical setting.

CONCLUSION

Both the CobraPLA and the SLIPA are intended for use during short procedures under general anesthesia, and have comparable efficacy and complication rates in comparison to the LMA Classic. Both airways may be considered as primary SGA devices, and the CobraPLA may be also be used as a rescue airway device.

Haemodynamic and Bispectral Index Response to Insertion of the Streamlined Liner of the Pharynx Airway (SLIPA™): Comparison with the Laryngeal Mask Airway

The newly developed supralaryngeal airway Streamlined Liner of the Pharynx Airway (SLIPA™) has been compared successfully to the LMA™, but the haemodynamic response to its insertion has not been evaluated in a randomised study. We compared haemodynamic and Bispectral index(BIS) responses to insertion of the SLIPA™ with classic LMA™ after standardising the anaesthetic technique using BIS to monitor and control the anaesthetic depth. One hundred patients were randomised to receive either a classic LMA™ or SLIPA™ following induction with fentanyl and propofol titrated to a target BIS of 40 and compared heart rate, mean arterial pressure and BIS responses to insertion. There was a significant rise in mean arterial pressure from the pre-stimulus value (73.8 [10.6] mmHg, mean ± SD) at two and three minutes (P <0.05) following insertion of the LMA™ with maximum rise (80.8 [11.5] mmHg) seen at two minutes. There was a significant rise in mean arterial pressure from the pre-stimulus value (73.2 [12.6] mmHg) atone, two, three, four and five minutes (P <0.05) following insertion of the SLIPA™ with maximum rise (86.9 [15.1] mmHg) observed at three minutes. Mean arterial pressure was significantly higher (P <0.05) with SLIPA™ at two, three, four and five minutes. BIS increased significantly (P <0.05) at one, two, three, four and five minutes following insertion of both the devices, but there was no significant difference between the groups. There was a significantly higher (P=0.001) incidence of blood on the device with the SLIPA™ (20/50 vs. 6/50 with LMA™). Thus, insertion of SLIPA™ causes significantly higher blood-pressure response but similar BIS response compared to the LMA™.

Advantages of ProSeal and SLIPA airways over tracheal tubes for gynecological laparoscopies

PURPOSE

To compare the efficacy of the ProSeal LMA and SLIPA supralaryngeal airways (SLA) with the standard tracheal tube (TT) in 150 consecutive day-case laparoscopic gynecological surgery procedures requiring general anesthesia.

METHODS

One hundred and fifty patients were randomized into three groups. An identical general anesthesia technique was used in all patients apart from the addition of muscle relaxants and reversal drugs in the TT group. Patients were excluded if there were risk factors for gastroesophageal reflux. Ease of use, quality of seal, ventilation, systolic pressure, response to intubation, side effects and operating room time were assessed.

RESULTS

Both ProSeal LMA and SLIPA were easy to insert (100% success) and ventilate with respective mean (standard deviation) maximum sealing pressures of 31 (4.6) and 30 (5.2) cmH2O (P = 0.4) with no muscle relaxants. The seal quality in both ProSeal LMA and SLIPA permitted the use of low flows, 485 (291) and 539 (344) mL x min(-1) (P = 0.2) respectively, although in the TT group significantly lower flows [377 (124) mL x min(-1)], (P < 0.01) were achieved. Systolic pressure in the SLA groups was more stable in response to insertion than in the TT. With ProSeal there was a lower incidence of sore throats than with TT (30% vs 57%), (P < 0.05), but there was a lesser difference as compared with SLIPA (30% vs 49%), (P > 0.05). With both SLAs, there was a significant reduction in operating room time (> three minutes), (P < 0.001).

CONCLUSIONS

These results suggest that the ProSeal LMA (reusable) and SLIPA (single-use) SLAs were easy to use without requiring muscle relaxants, and reduce operating room time compared to the TT technique in day case laparoscopies.