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Anesthesiology:
Correspondence

Valve Leaks with New Disposable Extraglottic Airway Devices

van Zundert, André M.D., Ph.D., F.R.C.A.*; Al-Shaikh, Baha F.C.A.R.C.S.I., F.R.C.A.; Brimacombe, Joseph M.D., M.B., Ch.B., F.R.C.A.; Mortier, Eric M.D., Ph.D.

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In Reply:—

We apologize for the typographical error in our article.1 The first sentence should have read: “We would like to report six cases of spontaneous cuff deflation that occurred during a clinical trial conducted by our group of a new disposable extraglottic airway device, the CobraPLA™ (Engineered Medical Systems, Inc. Indianapolis, IN).”2 The intention behind citing the article by Akca et al.,2 which we do not wish to delete, was to direct readers to previous general work on the CobraPLA™. We were fully aware that Akca et al.2 had no problems with such leaks.
It is our practice to monitor continuously the cuff pressure of supraglottic airway devices during anesthesia, because cuff pressure can both increase (potential laryngopharyngeal trauma) or decrease (potential loss of seal). In our clinical study (unpublished data), we noted that in six cases using the CobraPLA™, the cuff pressure decreased completely to 0, although we had checked its adequacy before use as instructed by the manufacturer, which did not reveal any cuff leakage. After removal of the CobraPLA™, on checking, we were surprised to find an adequate cuff. However, further exploration by submersion in water revealed air escaping from the pilot balloon valve, showing a continuous leak at the cuff deflator valves with their surroundings. Because supraglottic airway devices are not regularly tested for this problem before their use, these kind of leaks go unnoticed, possibly putting the patient at risk. It was our intention to urge manufacturers of supraglottic airway devices to ensure quality control on the cuff deflator valves. These valve leaks are a further support for our believe that cuff pressure monitoring should be routine practice when using supraglottic airway devices.
André van Zundert, M.D., Ph.D., F.R.C.A.,*
Baha Al-Shaikh, F.C.A.R.C.S.I., F.R.C.A.
Joseph Brimacombe, M.D., M.B., Ch.B., F.R.C.A.
Eric Mortier, M.D., Ph.D.
*Catharina Hospital-Brabant Medical School, Eindhoven, The Netherlands. zundert@iae.nl
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References

1. Van Zunert A, Al-Shaihk B, Brimacombe J, Mortier E: Valve leaks with new disposable extraglottic airway devices. Anesthesiology 2005; 103:213

2. Akca O, Wadhwa A, Sengupta P, Durrani J, Hanni K, Wenke M, Yucel Y, Lenhardt R, Doufas AG, Sessler DI: The new perilaryngeal airway (CobraPLA) is as efficient as the laryngeal mask airway (LMA) but provides better airway sealing pressures. Anesth Analg 2004; 99:272–8

© 2006 American Society of Anesthesiologists, Inc.

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