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Minerva Anestesiologica 1999 December;65(12):823-30


language: English

Do we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)

Casati A., Fanelli G., Casaletti E., Cappelleri G., Magistris L., Aldeghei G.

Department of Anesthesiology, University of Milan, IRCCS H. San Raffaele, Milan


Background. The laryn­geal ­mask air­way (LMA) has ­been wide­ly stud­ied for ­both con­ven­tion­al and non­con­ven­tion­al ­uses, ­while the lit­er­a­ture on the ­cuffed oroph­a­ryn­geal air­way (COPA) is ­still lim­it­ed. The pur­pose of ­this man­u­script was to ­review the ­initial apprai­sal of effi­ca­cy, safe­ty, ­effects on hemo­dy­nam­ics and res­pir­a­to­ry func­tion, induc­tion ­agents and ­drug require­ments of ­this new supra­glot­tic ­device.
Methods. We ­reviewed ­main ­results of stud­ies recent­ly pub­lished on ­peer ­reviewed jour­nals con­cern­ing the clin­i­cal ­uses of ­COPA.
Results. When ­used in ­healthy ­adults under­go­ing gen­er­al anes­the­sia for rou­tine ­minor pro­ce­dures, the ­COPA and LMA are sub­stan­tial­ly equiv­a­lent. The LMA is asso­ciat­ed ­with a high­er ­first-­time place­ment ­rate and few­er manip­u­la­tions dur­ing ­usage, but the inci­dence of air­way unto­ward ­events dur­ing ­COPA anes­the­sia is equiv­a­lent to ­that report­ed ­when ­using an LMA. The qual­ity of breath­ing and cap­nog­ra­phy dur­ing ­COPA ven­ti­la­tion is sim­i­lar to ­that pro­vid­ed by the LMA ven­ti­la­tion, ­with clin­i­cal­ly rel­e­vant ­decrease in the phys­io­log­i­cal dead­space / ­tidal vol­ume ­ratio and arte­ri­al to end-­tidal CO2 ten­sion dif­fer­ence com­pared ­with face­mask ven­ti­la­tion. In select­ed ­patients with­out ­risk fac­tors for regur­gi­ta­tion of gas­tric con­tent, pos­i­tive-pres­sure ven­ti­la­tion is sim­i­lar­ly suc­cess­ful and ­safe ­with the ­COPA as ­with the LMA. The ­COPA ­seems to be ­less stim­u­lat­ing ­than LMA ­because it has ­been dem­on­strat­ed to ­cause a low­er inci­dence of pha­ryn­geal trau­ma and ­sore ­throat in the imme­di­ate post­op­er­a­tive peri­od, ­requires short­er expo­sure to an inha­la­tion­al anes­thet­ic and low­er con­cen­tra­tions of pro­pof­ol to be suc­cess­ful­ly ­placed, and is asso­ciat­ed ­with low­er ­effects on the ­patient’s hemo­dy­nam­ic homeo­sta­sis ­than LMA.
Conclusions. More exten­sive clin­i­cal eval­u­a­tions ­should be advo­cat­ed to bet­ter under­stand the ­risk / ben­e­fit ­ratio of ­this new supra­glot­tic ­device; how­ev­er, it may be con­clud­ed ­that in ­healthy ­adults receiv­ing gen­er­al anes­the­sia for ­short pro­ce­dures the ­COPA ­allows for an effec­tive and ­safe con­trol of the ­patient’s air­way and ven­ti­la­tion.

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