Novel supraglottic airway device for ophthalmic procedures

Dear Editor, Ophthalmic procedures like strabismus surgery, vitreoretinal surgery and laser indirect ophthalmoscopy are frequently performed in the paediatric age group. Supraglottic airway devices (SADs) are commonly used for ophthalmic procedures. However, there are chances of dislodgement or displacement of SADs with rigid and protruding air tube due to the hand movements of the ophthalmologist in the vicinity.[1,2] To address this concern, we wanted to increase the angulation of the air tube of SAD at the lip, so that the air tube can be directed towards the chin. To achieve this goal, we ingeniously combined two (1.0; 1.5 and 1.5; 2.0) sizes of AMBU® AURA 40TM reusable laryngeal mask (LM) (AMBU A/S, Ballerup, Denmark) [Figure 1]. Smaller-sized AMBU® AURA 40TM LM was cut just beyond the end of the inflation line, and larger-sized AMBU® AURA 40TM LM was cut to use the curvature part. Then, both AMBU® AURA 40TM LMs were joined, so that larger AMBU® covered the smaller AMBU®, forming a device that provided an optimal angle at the lip. We took care to have a joint at the level of the lip to observe any disconnections [Figure 1b]. This device is easy to insert and allows ophthalmologists to perform eye surgeries without discomfort to access the desired surgical field and without risk of displacement of SAD [Figure 1d]. We have used this novel device in 50 preterm and ex-premature infants weighing more than 3.0 kg with spontaneous and controlled ventilation without any undue increase in airway pressure, end-tidal carbon dioxide or decreased expired tidal volume and with excellent surgeon’s satisfaction.Figure 1: (a) Novel supraglottic airway device. (b and c) Novel supraglottic airway device in situ depicting joint outside the lip with angulation. (d) Maneuverability of ophthalmologist during laser indirect ophthalmoscopySince it is an indigenous device and has not undergone any rigorous safety evaluation, it should be used only when other devices are not available due to medical and safety concerns, such as the risk of disconnection, loosening of joints, and gas leaks. Declaration of Patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient consented to the images and other clinical information being reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.