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Evaluation of the Cobra perilaryngeal airway (CPLA) as an airway conduit*

Published online by Cambridge University Press:  01 October 2007

J. J. Lee ,
J. A. Kim ,
M. S. Gwak  and
M. H. Kim
J. J. Lee
Affiliation:
Sungkyunkwan University, School of Medicine, Samsung Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Korea
J. A. Kim*
Affiliation:
Sungkyunkwan University, School of Medicine, Samsung Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Korea
M. S. Gwak
Affiliation:
Sungkyunkwan University, School of Medicine, Samsung Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Korea
M. H. Kim
Affiliation:
Sungkyunkwan University, School of Medicine, Samsung Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Korea
*
Correspondence to: Jie Ae Kim, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. E-mail: jakim@smc.samsung.co.kr; Tel: +82 2 3410 2470; Fax: +82 2 3410 0361
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Summary

Background and Objective

The effectiveness of the Cobra perilaryngeal airway as a routine airway device and as a conduit for tracheal intubation has not been prospectively studied to date. This study aimed to evaluate the Cobra perilaryngeal airway for its potential role in an emergency airway rescue, by analysing its use as a bridge to blind or fibre-optic-guided intubation.

Methods

In 49 patients, the procedure was carried out as follows: fibre-optic view through the Cobra perilaryngeal airway was assessed after the insertion of the Cobra perilaryngeal airway, then blind intubation through the Cobra perilaryngeal airway was attempted. After evaluating the success of blind intubation, fibre-optic-guided intubation was performed through the Cobra perilaryngeal airway. The endotracheal tube was removed after evaluating the success of fibre-optic-guided intubation, and then conventional laryngoscopy was carried out to evaluate the Cormack & Lehane grade and airway trauma.

Results

In all, 95.9% (47/49) of patients had adequate ventilation using the Cobra perilaryngeal airway; the success rates for the blind and fibre-optic-guided intubation were 36.2% and 83.0%, respectively. The patients were divided into two groups according to the fibre-optic view. Group 1 included patients with an obstructed view by an anterior grill of the Cobra perilaryngeal airway head, and a view of the anterior epiglottis (downfolded epiglottis) with or without a visible larynx (16/47, 34.0%). Group 2 included the remaining patients (31/47, 66.0%). The success rates of the blind and fibre-optic intubations were different between the two groups (blind intubation: 12.5% vs. 48.4%, fibre-optic intubation: 62.5% vs. 93.6%, P < 0.05). The success rates of blind and fibre-optic-guided intubations were not different according to the Cormack & Lehane grading (P > 0.05). 42.6% of patients had blood staining after removing the device and complications such as trauma and oedema were confirmed under direct laryngoscopy.

Conclusion

This study suggests that the Cobra perilaryngeal airway could be a useful airway device as a vehicle for fibre-optic-guided intubation; however, it needs caution against airway trauma.

Keywords

ANAETHESIA GENERALLARYNGEAL MASKS, Cobra perilaryngeal maskINTUBATION INTRATRACHEAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 852 - 855
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

*

This study does not have any financial relationship with any device companies.

References

1.Farrow, C, Cook, T. Pulmonary aspiration through a Cobra PLA. Anaesthesia 2004; 59: 1140–1141.CrossRefGoogle ScholarPubMed
2.Cook, TM, Lowe, JM. An evaluation of the Cobra PeriLaryngeal Airway: study halted after two cases of pulmonary aspiration. Anaesthesia 2005; 60: 791–796.CrossRefGoogle ScholarPubMed
3.Szmuk, P, Ezri, T, Narwani, A, Alfery, DD. Use of CobraPLA as a conduit for fiberoptic intubation in a child with neck instability (letter). Paediatr Anaesth 2006; 16: 217–218.CrossRefGoogle Scholar
4.Szmuk, P, Ezri, T, Akca, O, Alfery, DD. Use of a new supraglottic airway device – the CobraPLA – in a ‘difficult to intubate/difficult to ventilate’ scenario. Acta Anaesthesiol Scand 2005; 49: 421–423.CrossRefGoogle Scholar
5.Agro, F, Barzoi, G, Carassiti, M, Galli, B. Getting the tube in the oesophagus and oxygen in the trachea: preliminary results with the new supraglottic device (Cobra) in 28 anaesthetised patients. Anaesthesia 2003; 58: 920–921.CrossRefGoogle ScholarPubMed
6.Agro, F, Barzoi, G, Galli, B. The Cobra PLA in 110 anaesthetized and paralyzed patients: what size to choose? (letter). Br J Anaesth 2004; 92: 777–778.CrossRefGoogle Scholar
7.Khan, RM, Maroof, M, Johri, A, Ashraf, M, Jain, D. Cobra PLA can overcome LMA failure in patients with face and neck contractures (letter). Can J Anesth 2005; 52: 340.CrossRefGoogle Scholar
8.Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.CrossRefGoogle ScholarPubMed
9.Benumof, JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84: 686–699.CrossRefGoogle ScholarPubMed
10.Benumof, JL. A new technique of fiberoptic intubation through a standard LMA (letter). Anesthesiology 2001; 95: 1541.CrossRefGoogle Scholar
11.Rajan, GR. Fiberoptic wire-guided transoral and through the LMA intubation technique using modified gum elastic bougie. Anesth Analg 2005; 100: 599–600.CrossRefGoogle ScholarPubMed
12.Breen, PH. Simple technique to remove laryngeal mask airway ‘guide’ after endotracheal intubation (letter). Anesth Analg 1996; 82: 1302.Google Scholar
13.Brimacombe, J. Laryngeal mask anesthesia: Principles and practice, 2nd edn. Philadelphia: Saunders, 2005: 156–157.Google Scholar
14.Preis, C, Preis, I. Removal of the connector on the laryngeal mask airway provides a useful alternative to the intubating laryngeal mask. Can J Anesth 2001; 48: 600–603.CrossRefGoogle Scholar
15.Walburn, MB, Cornes, J, Ryder, IG. Fiberoptic intubation through a laryngeal mask airway facilitated by a guide wire. Anaesthesia 2000; 55: 1027–1028.CrossRefGoogle ScholarPubMed
16.Mayhew, JF. Continuous monitoring of the end tidal CO2 ensures that the endotracheal tube remains in place during the removal of the LMA. Anesth Analg 2004; 98: 1814.CrossRefGoogle ScholarPubMed
17.Rowbottom, SJ, Simpson, DL, Grubb, D. The laryngeal mask airway in children. A fiberoptic assessment of positioning. Anaesthesia 1991; 46: 489–491.CrossRefGoogle ScholarPubMed
18.Goudsouzian, NG, Denman, W, Cleveland, R, Shorten, G. Radiologic localization of the laryngeal mask airway in children. Anesthesiology 1992; 77: 1085–1089.CrossRefGoogle ScholarPubMed
19.Turan, A, Kaya, G, Koyuncu, O, Karamanlioglu, B, Pamukcu, Z. Comparison of the laryngeal mask (LMA) and laryngeal tube (LT) with the new perilaryngeal airway (CobraPLA) in short surgical procedures. Eur J Anaesthesiol 2006; 23: 234–238.CrossRefGoogle Scholar
20.Zundert, A, Al-Shaikh, B, Brimacombe, J, Koster, J, Koning, D, Mortier, EP. Comparison of three disposable extraglottic airway devices in spontaneously breathing adults. Anesthesiology 2006; 104: 1165–1169.CrossRefGoogle ScholarPubMed