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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 November;66(11):811-7

language: English

Italian experience with the cuffed oropharyngeal airway (COPA). A prospective, observational study

Fanelli G., Casati A. on Behalf of the Italian COPA group

From the Depart­ment of Anes­the­sio­lo­gy IRCCS H. San Raf­faele Uni­ver­sity of ­Milan


Back­ground. The ­cuffed oroph­a­ryn­geal air­way (­COPA) has ­been recent­ly intro­duced ­into the mar­ket, but few is ­known ­about its clin­i­cal use in Ita­ly. We there­fore con­duct­ed a pros­pec­tive, obser­va­tion­al inves­ti­ga­tion to eval­u­ate the use of ­this new extrat­ra­cheal air­way in clin­i­cal prac­tice.
Meth­ods. Anes­the­sio­lo­gists par­tic­i­pat­ing in the ­study ­received a sim­ple ques­tion­naire ­where ­data con­cern­ing anthro­po­met­ric var­i­ables, sur­gi­cal pro­ce­dure, ­type and dos­es of ­drugs ­used to ­induce and main­tain gen­er­al anes­the­sia, ­type of ven­ti­la­tion dur­ing the pro­ce­dure, and occur­rence of unto­ward ­events dur­ing ­either ­COPA place­ment, gen­er­al anes­the­sia main­te­nance, or post­op­er­a­tive peri­od ­were pros­pec­tive­ly record­ed. The num­ber of pre­vi­ous­ly ­placed ­COPA, and the ade­qua­cy of air­way con­trol (sub­jec­tive ­four ­point ­scale: excel­lent, ­good, ­fair, and ­poor) ­were ­also ­assessed.
­Results. A ­total of 210 ­patients (139 ­female and 71 ­male) ­were pros­pec­tive­ly stud­ied. Gen­er­al anes­the­sia was ­induced ­with pro­pof­ol in 204 ­patients (98%), sodi­um thi­o­pen­tal in 3 ­patients (1.5%), and mid­az­o­lam in 1 ­patient (0.5%); ­while ­only one ­patient ­received mus­cle relax­ants (0.5%); 126 ­patients (64%) ­were spon­ta­ne­ous­ly breath­ing ­while 71 ­patients (36%) ­received pos­i­tive pres­sure mechan­i­cal ven­ti­la­tion. No dif­fer­enc­es in the inci­dence of unto­ward ­events was report­ed ­between spon­ta­ne­ous­ly breath­ing and mechan­i­cal­ly ven­ti­lat­ed ­patients. No dif­fer­enc­es in the inci­dence of unto­ward ­events ­were report­ed accord­ing to the num­ber of pre­vi­ous­ly ­placed ­COPA. Dif­fi­cul­ties in ­COPA place­ment ­were report­ed in 7 ­patients ­with nor­mal den­ti­ture (5%) and 9 ­patients (39%) ­with den­tal pros­the­sis (p=0.003), (­Odds ­Ratio: 5.1; Cl95%: 3.0-8.7). Fur­ther­more, air­way obstruc­tion was ­more fre­quent­ly report­ed in ­patients ­with den­tal pros­the­sis (8% vs 0%; p=0.002). The ­seal pres­sure was high­er in mechan­i­cal­ly ven­ti­lat­ed (17±10 cm H2O) ­than spon­ta­ne­ous­ly breath­ing ­patients (10±8 cm H2O), (p=0.0005), ­while a seal­ing pres­sure high­er ­than 12 cm H2O was asso­ciat­ed ­with an ­increased ­risk for post­op­er­a­tive ­sore ­throat (Odds ­ratio: 4.3; Cl95%: 2.6-7.1; p=0.002). Air­way con­trol was grad­ed as excel­lent in 61.4% of cas­es by phy­si­cian pre­vi­ous­ly plac­ing ­more ­than 50 ­COPA, com­pared ­with ­only 26.5% ­when ­less ­than 50 ­COPA had ­been pre­vi­ous­ly ­placed (p=0.0005).
Con­clu­sions. ­COPA pro­vid­ed as ­safe and effec­tive air­way man­age­ment in mechan­i­cal­ly ven­ti­lat­ed ­patients as ­that ­observed dur­ing spon­ta­ne­ous breath­ing. Expe­ri­ence ­with ­COPA place­ment had no ­effects on the place­ment suc­cess ­rate or inci­dence of unto­ward ­events, but ­improved the qual­ity of air­way con­trol.

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