THE GLOTTIC APERTURE SEAL AIRWAY - A NEW VENTILATORY DEVICE

Background: None of the presently used airway devices are ideal regard ing ease of insertion, alignment with the laryngeal inlet, and provisi on of a high-pressure seal from the environment. The purpose of this s tudy was to determine, in awake volunteers, the performance of a new v entilatory device, the glottic aperture seal airway, regarding ease of insertion, alignment with the laryngeal inlet, and forced exhalation seal pressure (PFES). Methods: The glottic aperture seal airway consis ts of a curved tubular component that ends in the middle of an ellipti cal foam cushion glottic component. The posterior surface of the foam has a curved flexible plastic backing, which imparts a 60 degrees angl e between the proximal half and the distal half of the foam cushion. W hen the glottic aperture seal airway is properly in situ in a supine p atient, the proximal half of the foam cushion is opposite the laryngea l inlet. The posterior surface of the plastic backing has a balloon at tached to it. Inflation of the balloon presses the ventilation hole an d foam cushion up against the laryngeal inlet, thereby creating a seal from the environment. Using the laryngeal mask airway as a control de vice, the glottic aperture seal airway was tested for time and ease of insertion, fiberoptic alignment with the laryngeal inlet, and PFES in 18 lightly sedated and locally anesthetized volunteers. Results: The glottic aperture seal and laryngeal mask airways were inserted with eq ual ease and speed. The fiberoptic alignment with the larynx was excel lent for both the glottic aperture seal and laryngeal mask ah-ways. In all volunteers, the mean +/- SD PFES values at 0-, 10-, 20-, 30-, and 40-ml balloon inflation volumes of the glottic aperture seal airway w ere 23.4 +/- 11.8, 29.6 +/- 12.4, 42.7 +/- 12.5, 56.9 +/- 5.6, and 60 +/- 0 cm H2O, respectively; the PFES at greater than or equal to 20 ml balloon inflation volume of the glottic aperture seal airway was sign ificantly greater than with the laryngeal mask airway (19.4 +/- 6.7 cm H2O, P < 0.01). A PFES of 60 cm H2O was achieved with the glottic ape rture seal airway in all volunteers (n = 2 at 10 ml, n = 3 at 20 ml n = 9 at 30 ml, and n = 4 at 40 ml). The glottic aperture seal airway di d not cause any trauma. Conclusion: In awake volunteers, the glottic a perture seal and laryngeal mask airways were equally easy to insert an d position. The glottic aperture seal airway was capable of achieving a higher PFES than the laryngeal mask airway.