Overview

Supraglottic Airway (SGA) insertion is a rapid airway management technique used when endotracheal intubation is not immediately available or as a bridge to definitive airway management. SGAs provide adequate ventilation in most pediatric patients.

SGAs are essential for emergency airway management when bag-mask ventilation is inadequate and endotracheal intubation is not feasible. They provide a reliable airway with minimal training requirements and can be life-saving in emergency situations.

Learn more in our comprehensive RxDx Pediatrics Course

Indications

✓
Failed Bag-Mask Ventilation

Inability to maintain adequate oxygenation with bag-mask

✓
Failed Intubation

Multiple failed intubation attempts

✓
Emergency Airway

Rapid airway establishment in emergency

✓
Cardiac Arrest

As part of resuscitation algorithm

✓
Elective Surgery

Selected surgical procedures

Contraindications

Absolute Contraindications

✗ Complete upper airway obstruction
✗ Severe maxillofacial trauma
✗ Patient or family refusal

Relative Contraindications

✗ Mild respiratory distress
✗ Stable patient with adequate oxygenation
✗ Limited experience with device

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes selecting appropriate SGA size, ensuring the device is properly lubricated, assembling the insertion team, and preparing backup airway equipment. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Device Selection

Select appropriate SGA size based on patient weight. Prepare device with lubricant. Check cuff integrity if applicable.

⚠️ Common Mistakes to Avoid:

  • Wrong device size
  • Inadequate lubrication
  • Damaged device

💡 Pro Tip:

Use weight-based sizing charts for accurate device selection.

Step 2: Patient Positioning

Position patient in sniffing position. Ensure adequate sedation and paralysis if indicated. Prepare for insertion.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate sedation
  • Patient movement

💡 Pro Tip:

Proper positioning is crucial for successful insertion.

Step 3: Insertion Technique

Insert device along hard palate. Advance until resistance is felt. Inflate cuff if applicable. Confirm placement.

⚠️ Common Mistakes to Avoid:

  • Poor insertion angle
  • Inadequate advancement
  • Failure to inflate cuff

💡 Pro Tip:

Follow the natural curve of the oropharynx during insertion.

Step 4: Placement Confirmation

Confirm placement with chest rise, breath sounds, capnography, and absence of gastric insufflation.

⚠️ Common Mistakes to Avoid:

  • Relying on single confirmation method
  • Poor auscultation technique
  • Inadequate monitoring

💡 Pro Tip:

Use multiple methods to confirm proper placement.

Step 5: Device Securing

Secure device with tape or commercial device. Connect to ventilator or bag. Monitor ventilation.

⚠️ Common Mistakes to Avoid:

  • Poor device securing
  • Inadequate monitoring
  • Poor connection

💡 Pro Tip:

Secure the device properly to prevent dislodgement.

Step 6: Ventilation Management

Monitor ventilation parameters, oxygen saturation, and end-tidal CO2. Adjust as needed.

⚠️ Common Mistakes to Avoid:

  • Inadequate monitoring
  • Poor ventilation parameters
  • Failure to adjust

💡 Pro Tip:

Monitor continuously and adjust ventilation as needed.

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Post-procedure Care

Post-insertion care involves confirming proper placement, securing the device, monitoring ventilation and oxygenation, and preparing for definitive airway management if needed.

Complications & Management

Complication Incidence Signs Management Prevention
Malposition 5-10% Poor ventilation, gastric insufflation Reposition or replace device Proper insertion technique, confirmation
Gastric insufflation 10-15% Abdominal distention, decreased ventilation Reposition device, consider NG tube Proper placement, appropriate pressure
Sore throat 20-30% Patient complaint, dysphagia Symptomatic treatment Proper lubrication, gentle technique
Device dislodgement 5-10% Decreased ventilation, air leak Reposition or replace device Proper securing, monitoring

Clinical Pearls

💡

Use weight-based sizing charts for accurate device selection.

🎯

Follow the natural curve of the oropharynx during insertion.

⚡

Use multiple methods to confirm proper placement.

🔍

Secure the device properly to prevent dislodgement.

📊

Monitor continuously and adjust ventilation as needed.

🎨

Proper positioning is crucial for successful insertion.

⚠️

Always have backup airway equipment available.