It All Adds Up: The New Face of Supraglottic Superiority

new face of SS

It All Adds Up: The New Face of Supraglottic Superiority

In this present day of cost analysis, it’s important to have a big macro picture of all things effecting patient care. Many of these may not be included on a spread sheet or be intuitive to a CEO running healthcare. For example, in airway management all supraglottic devices are all basically the same. To some degree each practitioner of course has their own preferences, but does it really matter? It’s easy to say that this supraglottic airway is $4 cheaper with similar outcomes, right?

But what are we comparing? Let’s take a closer look.

Each minute of operating room time cost a minimum of $50 and the operating room sequence does not start until induction of anesthesia and establishment of a secure airway. Delays in securing the airway cost time and money to the organization. Prior to routine intubation and post induction, most people would bag mask ventilate to bridge time allowing muscle relaxants to take effect. Bag mask ventilation can introduce air into the stomach more easily than supraglottic airway ventilation. Stomach air has been shown to increase risk of nausea and vomiting in the recovery room. Bag mask ventilation, possible failure to ventilate and placement of an oral airway add time and money. Additionally, antiemetics and delayed discharge can result in significant cost, not to mention patient discomfort. Jaw thrust maneuvers can add postoperative discomfort and this scenario is quite common in obese patients with obstructive sleep apnea (OSA).

surgeryInduction of anesthesia with resultant loss of airway reflexes creates the need for airway intervention. Studies show that supraglottic airway insertion times can take 5 seconds or less to establish ventilation. Too many organizations have airway disasters because of no established alternative to video laryngoscopy or the use of a normal laryngeal airway mask. The traditional fiberoptic bronchoscope (FOB) is part of the ASA algorithm but has become unfamiliar with many people. There is currently little to no practice or use of the FOB by many practitioners.

The current plan A is to reach for the video laryngoscope. This is a great device and has prevented many of the worst airway disasters, but it doesn’t provide ventilation if failure occurs. Plan B is the the supraglottic laryngeal airway mask. Although another wonderful device, if it fails to seat, ventilation is compromised. Throughout all of this, we still can’t visualize during placement or ventilation. It would be best of all to ventilate while you’re visualizing your intubation. Morbid obesity, hypoxia, secretions, and bloody mouth with some significant anxiety are all clearly in play if both plan A and B fail.

What is plan C when a patient is literally dying?

Toad deviceThe TOAD™ LIVVE™ device provides the solution to this catch-22. Practitioners and organizations practicing with this new device in standard airway situations find themselves in a new paradigm shift. The LIVVE™ has the ability to provide supraglottic ventilation, blind intubation and continued visualization with its designated camera channel. We believe continued visualization during placement will lay the foundation for the next generation in airway management. Having ownership for an alternative plan that is easily practiced daily or weekly is the best advocate for patient safety.

The need for an everyday, simple rescue airway device that easily establishes ventilation is immeasurable and of immense importance. The ability to blindly intubate or add a flexible camera to provide visualized placement adds layers of safety to both patient and organizations. This creates a new pathway for each airway practitioner to use this device daily. Reinforcing rescue skills not presently available empowers them with a simplified use of the FOB. Having the versatility of the LIVVE™ in your hands for routine intubations will create a new algorithm of practice and preparedness for when the most difficult airway situations occur. Are these points taken into effect when an airway device is being reviewed? It all adds up. The $4 differences easily becomes the best value proposition for the patient, practitioner and organization.

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