A novel technique for securing supra-glottic airway device to prevent mal-positioning.

Sir,

Fixing of supra-glottic airway device with adhesive tape after proper placement may not be adequate. Many times, traction, weight of the tubes, heat and moisture exchange filter and unanticipated extubation force can displace a properly placed supra-glottic device. Different methods are used, i.e. Thomas’ tube holder, adhesive tape, Micropore™, Leucoplast™, quill tape and suture to fix endotracheal tubes.[1234] Similar techniques are also used for securing supra-glottic devices on tube holder, bed, shoulder, etc., but they are cumbersome and may displace during movement. Supra-glottic devices thus need to be secured properly to prevent malposition.

We have devised a very easy and simple technique for their effective fixation. We place the two limbs of the circle system tubings (inspiratory and expiratory) on either side of the head, bringing the ‘Y’ connector and distal part of the circle system tube to sit comfortably on the chest [Figure 1]. Then, we connect the supra-glottic device with an angle connector. Thus, weight of the tube, HME filter and shaft of supra-glottic device can be balanced and chance of displacement minimised. This assembly also gives much more flexibility in case of inadvertent traction on tube or head movement as two limbs of circle system tube and shaft of supra-glottic device anchor the system like a tripod distributing the force evenly [Figure 2].

Figure 1

Two limbs of the corrugated circle system tube on either side of the head bringing the ‘Y’ connector and distal part of circle system tube to sit comfortably on the chestsurgery

Figure 2

Two limbs of circle system tube and shaft of supra-glottic device anchor the system like a tripod distributing the force evenly

Displacement of a supra-glottic device after its perfect placement is quite common and poses a challenge to anaesthesiologist.[5] Repositioning the supra-glottic device in the middle of the surgery can be quite difficult which is preventable by proper securement. Only adhesive tape at lips or jaw may not be adequate to prevent displacement, especially rotational mal-positioning by unanticipated traction force during patient positioning or transport. Although we found no difficulties in surgeries involving eyes, scalp, ears and most of the facial area with the supra-glottic device, during endonasal surgery and surgery involving lower part of the face, neck and upper part of the chest, it will not be possible to use this fixation technique. Another limitation can be kinking of the shaft of supra-glottic device under surgical drape if excessive pressure is put on the assembly. Further, this technique is not applicable for the coaxial circuit.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.