Which airway should I use?

PURPOSE OF REVIEW: To summarize recent findings for the optimal airway device for patients in the operating room and for medical personnel with limited experience in out-of-hospital airway management.

RECENT FINDINGS: Extraglottic airway devices, like the laryngeal mask airway, are increasingly used for airway management in patients undergoing elective surgery. New devices with separate gastric access reduce the risk of aspiration, providing higher airway seal pressure and extending the range of clinical use (e.g., for patients with surgical procedures in the prone position). The major advantages are reduced airway morbidity and less significant cardiovascular responses. Extraglottic airway devices insertion is easier to learn, and the skill is better retained. Failure to secure the airway in critically ill emergency patients can drastically increase the likelihood of poor or fatal outcome. Recently published studies recommend a shift in the curriculum for medical students and other healthcare providers from conventional laryngoscopic tracheal intubation towards the use of extraglottic airway devices. The intubating laryngeal mask might play a major role because it facilitates both ventilation and tracheal intubation.

SUMMARY: Extraglottic airway devices are increasingly used for airway management not only in patients for elective surgery, but also in out-of-hospital settings, when less experienced personnel have to secure the airway.