Tim’s top tips for airway management 2013 to 2024 a 🧵 Was asked to discuss some top tips at @GAMCLondon Let’s start in 2013 Was asked to write a paper on this for Anesthesiology News in 2013 I leant heavily on NAP4 Sadly no link to the article but you should be able to piece the article together from the pictures. 1/n

Great thread Cliff Please allow my minor pedantry & high geekery The tip of the (standard) igel does not reach the top of the oesophagus For most SGAs this is true but not for the igel. If you line up the airway orifices of a series of SGAs you’ll find the igel is shorter from airway orifices to tip. During development Mohammed Nasir intentionally shaved of the tip bit by bit. This was intended to reduce ingress of the tip into the upper oesophageal sphincter (ie the horizontal fibres of cricopharyngeus) with tube aim of reducing dysphagia & dysphonia after anaesthesia. It worked with igel having better oropharyngeal recovery characteristics than other SGAs. However the downside was a poorer seal with the oesophagus. So compared with the ProSeal LMA (oesophageal seal 70 cmH2O, airway seal median >32 cmH2O) the igel has lower seals (10 cmH2O, & 24-26 cmH2O respectively). It also has a small drain tube [ & please let’s not call it a gastric drain]. This leads to a theoretical increase risk of aspiration with igel ba other high performing 1nd gen SGAs. It’s theoretical, unproven & likely unprovable…..but might be important particularly with the important role of igel in resus and PHEM. So now - if anyone’s left - we move to the igel plus. The redesign has reintroduced the longer tip so now IT WILL reach the upper oesophagus. I was chatting to Dr Nasir yesterday who explained that longer tip allows for -the ramp designed to facilitate intubation thru igel (FOB still recommended) -a larger drain tube -a perhaps unexpected increase in airway seal pressures I look forward to the objective evaluation of the new device. Some interesting things going on g on in the field of SGAs which has been a quiet area for a few years….

So the #NAP7 panel are deep diving into the enormous data on UK perioperative cardiac arrests collected in 2021-2 What would readers of this : patients, doctors, AHPs etc actually like us to include? What questions might we answer that we’ve yet to think of? @NAPs_RCoA