The modern extraglottic airway devices (post-1980) are listed in table 1 according to the proposed classification. Classification of Extraglottic Airway Devices by 1) Presence/Absence of a Cuff, 2) Oral/Nasal Route of Insertion; and 3) Anatomic Location of the Distal Portion. Features, comparisons, advantages, and disadvantages are provided for each device class. The UK Difficult Airway Society (DAS) has proposed a guideline whereby purchasers could adopt a minimum level of evidence before making a pragmatic decision about the purchase or use of an airway device. Classification of intubating devices based on the airway visualization technique (See "Airway management for induction of general anesthesia", section on 'Choice of airway device'.) Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Limitations of device exemptions are covered under 21 CFR XXX.9, where XXX refers to Parts 862-892. These devices cause gagging and the potential for vomiting and aspiration in conscious patients and so should be used with caution. Airway Innovation is a USA based distributor of dental devices specializing in mandibular repositioning devices for sleep apnea or snoring and anterior splints for bruxism (teeth grinding). Efficacy and safety therefore matter. Choice of supraglottic airway — There are multiple types of reusable and disposable LMAs and other supraglottic airways (SGAs) (picture 2 … We do not control or have responsibility for the content of any third-party site. The majority of general anaesthetics are now delivered with a supraglottic airway device (SAD) maintaining the airway. Fourth: whether the cuff is in the proximal pharynx (e.g. If the distal portion sits below the hypopharynx (esophagus) there is moderate  isolation. A: The deflated cuff is inserted into the mouth. Another airway clearance device is the oscillatory (or vibratory) positive expiratory pressure, a form of PEP that employs deep breathing and forced exhalation to achieve airway clearance via small, hand-held devices. Merck and Co., Inc., Kenilworth, NJ, USA (known as MSD outside the US and Canada) is a global healthcare leader working to help the world be well. B: With the index finger, the cuff is guided into place above the larynx. airways continuously open in people who are able to breathe spontaneously on their own, but need help keeping their airway unobstructed. There are numerous techniques for LMA insertion (see How to Insert a Laryngeal Mask Airway). Bag-valve-mask devices consist of a self-inflating bag (resuscitator bag) with a nonrebreathing valve mechanism and a soft mask that conforms to the tissues of the face; when connected to an oxygen supply, they deliver from 60 to 100% inspired oxygen (see also How To Do Bag-Valve-Mask Ventilation). Editor—The term ‘third generation supraglottic airway’ (SAD) has recently been used in a number of settings, both commercial and promotional, 1–4 and more recently, in the anaesthetic literature. Bridge between BMV and endotracheal intubation Useful in “Cannot Intubate, CannotVentilate” situations. In emergencies, laryngeal mask airways should be viewed as bridging devices. This relates to its efficacy to provide a clear airway and for ease of instrumentation of the respiratory tract; the shorter the distance between the distal airway aperture and the glottic inlet, the greater the efficacy of both—however, the distal airway aperture of most extraglottic airway devices is located in the laryngopharynx. A proposed classification system for extraglottic airway devices. This site complies with the HONcode standard for trustworthy health information: verify here. Learn more about our commitment to Global Medical Knowledge. Despite this, the use of these device may be associated with various complications including aspiration. I would like to propose a classification system for this increasingly complex family of devices. First: the anatomic location of the distal airway aperture. Choice of airway device for anesthesia is discussed separately. Airway Innovations is led by a team of experienced medical device executives, engineers, clinicians, and entrepreneurs. Once in the correct position, the mask is inflated. The relief valve can be shut off if necessary to provide sufficient pressure. Adapted from Levitan RM, Kinkle WC: The Airway Cam Pocket Guide to Intubation, ed. Extraglottic airway devices: technology update Bimla Sharma, Chand Sahai, Jayashree Sood Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India Abstract: Extraglottic airway devices (EADs) have revolutionized the field of airway management. SADs have also been called supraglottic airways and extraglottic or periglottic airway devices. A laryngeal mask airway or other supraglottic airway can be inserted into the lower oropharynx to prevent airway obstruction by soft tissues and to create an effective channel for ventilation (see figure Laryngeal mask airway). Second-generation devices have further improved efficacy and utility by incorporating design changes. Sometimes cuffs are not inflated or inflated only to the extent needed to prevent obvious leakage. Anesthesiology. 2. Comment in Anesthesiology. Table 1. The automatic assignment of class III occurs by operation of law and without any action b… If the seal is inadequate, mask pressure should be lowered somewhat; if this approach does not work, a larger mask size should be tried. The U.S. Food and Drug Administration (FDA) has issued a final rule, “ Classification of the Positive Airway Pressure Delivery System ,” effective Oct. 19, 2018, that reclassifies the positive airway pressure (PAP) delivery system, moving it from Class III into Class II. Device specifications were obtained from manufacturer correspondences. CLASSIFICATION BASED ON THE NUMBER OF LUMEN- 1.Single Lumen Devices:- LMA-classic, LMA-unique, LMA-flexible, ILMA, C-trach, Soft seal, Laryngeal Airway Device(LAD), Ambu Laryngeal Mask, Pharyngeal airway express(PAX), Cobra Perilaryngeal Airway(CPLA), Laryngeal Tube(LT), Cuffed oropharyngeal airway, Stream Lined Liner of the Pharyngeal Airway(SLIPA), Glottic Aperture Seal Device… The LMA is a tube with an inflatable cuff that is inserted into the oropharynx. The term supraglottic indicates that these devices sit just above the larynx and allow for oxygenation and ventilation. A: The head is flat on the stretcher; the airway is constricted. After failure of initial direct laryngoscopy, morbidity has been shown to increase when more than two at-tempts are made at laryngoscopy during emergency intubations performed beyond the operating room7. Complications include vomiting and aspiration in patients who have an intact gag reflex, who are receiving excessive ventilation, or both. A practitioner is most likely to administer atropine to an adolescent patient several minutes prior to laryngoscopy to decrease the risk for which of the following? If no spontaneous respiration occurs after airway opening and no respiratory devices are available, rescue breathing (mouth-to-mask or mouth-to-barrier device) is started; mouth-to-mouth ventilation is rarely recommended. James Cook University, Cairns Base Hospital, The Esplanade, Cairns, Australia. Newer versions of LMAs have an opening through which a small tube can be inserted to decompress the stomach. Placement typically requires laryngoscopy by a skilled practitioner, but a variety of novel insertion devices that provide other options are available (see Tracheal Intubation). Class 1 Device Recall Airway Gas Option NCAiO: Date Initiated by Firm: September 27, 2019: Create Date: January 10, 2020: Recall Status 1: Open 3, Classified: Recall Number: Z-0760-2020: Recall Event ID: 84034: 510(K)Number: K133576 Product Classification: Analyzer, gas, carbon-dioxide, gaseous-phase - Product Code CCK: The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual in the remainder of the world. Although drugs can be delivered via an endotracheal tube during cardiac arrest, this practice is discouraged. This review highlights the types and incidence of these complicatio… C: Once in place, the cuff is inflated. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Finally, it is worth noting that the term “extraglottic airway device” is more appropriate than “supraglottic airway device,” since many have components that are infraglottic, but all lie outside the glottis. Exhaled air contains 16 to 18% oxygen and 4 to 5% carbon dioxide, which is adequate to maintain blood oxygen and carbon dioxide values close to normal. The trusted provider of medical information since 1899. These devices use 2 balloons to create a seal above and below the larynx and have ventilation ports overlying the laryngeal inlet (which is between the balloons). Search for other works by this author on: This site uses cookies. If the distal portion sits above the hypopharynx (oral cavity, nasal cavity, nasopharynx, oropharynx and laryngopharynx†) there is no  isolation. An endotracheal tube also permits suctioning of the lower respiratory tract. As the name implies, these devices seal the laryngeal inlet (rather than the face-mask interface) and thus avoid the difficulty of maintaining an adequate face-mask seal and the risk of displacing the jaw and tongue. Some newer cuffs use a gel that molds to the airway rather than an inflatable cuff. THE Mallampati classification is a rough estimate of the tongue size relative to the oral cavity.1Although the single usage of the Mallampati classification has limited discriminative power for difficult tracheal intubation,2it is a simple, reproducible, and reliable preanesthetic airway assessment method when performed properly. Your students should read at least one article about Mallampati prior to or after class. Table 1. 2004 Aug;101(2):559. jbrimaco@bigpond.net.au, Joseph Brimacombe; A Proposed Classification System for Extraglottic Airway Devices. These devices use 2 balloons to create a seal above and below the larynx and have ventilation ports overlying the laryngeal inlet (which is between the balloons). Classification, Generations & Concepts There is considerable debate in the literature as to how supraglottic airway devices should be classified, with no clear consensus definition. First: whether the device is uncuffed or cuffed. Larger-than-necessary volumes of air may cause gastric distention with associated risk of aspiration. There are four other potential criteria for classification, but these are less suitable. Objective: The purpose of this evidence-based analysis is to examine the safety and efficacy of airway clearance devices (ACDs) for cystic fibrosis and attempt to differentiate between devices, where possible, on grounds of clinical efficacy, quality of life, safety and/or patient preference. Supraglottic airways are a group of airway devices used to secure a patient’s airway or as an aid to facilitate endotracheal intubation (ETI). Brimacombe J. (See also Overview of Respiratory Arrest, Airway Establishment and Control, and Tracheal Intubation.). Anesthesiology 2004; 101:559 doi: https://doi.org/10.1097/00000542-200408000-00054. Last full review/revision Apr 2020| Content last modified Apr 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Head and neck positioning to open the airway, How To Insert an Esophageal-Tracheal Combitube, The Airway Cam Pocket Guide to Intubation, Musculoskeletal and Connective Tissue Disorders, How To Insert an Esophageal-Tracheal Double Lumen Tube (Combitube®) or a King Laryngeal Tube, Emory University School of Medicine, Department of Anesthesiology, Division of Critical Care Medicine. , laryngeal mask airway); however, this only applies to the subset of cuffed extraglottic devices. An endotracheal tube is inserted directly into the trachea via the mouth or, less commonly, the nose. Another class of rescue ventilation devices is laryngeal tube or twin-lumen airways (eg, Combitube®, King LT®). Airway Devices Supraglottic Airway Devices Lies above the laryngeal inlet Infraglottic Airway Devices Lies below the laryngeal inlet in the trachea 3. B: Establishing the sniffing position, the ear and sternal notch are aligned, with the face parallel to the ceiling, opening the airway. Please confirm that you are a health care professional. *This relates to the potential degree of isolation of the respiratory and gastrointestinal tracts. The efficacy of the airway seal with an LMA, unlike endotracheal tubes, is not directly correlated with the mask inflation pressure. Bag-valve-mask devices do not maintain airway patency, so patients with soft-tissue relaxation require careful positioning and manual maneuvers (see figures Head and neck positioning to open the airway and Jaw lift), as well as additional devices to keep the airway open. Either the device should be removed (assuming ventilation and gag reflexes are adequate), or drugs should be given to eliminate the gag response and provide time for an alternative intubation technique. Upon request, FDA has classified the positive airway pressure delivery system as class II (special controls), which we have determined will provide a reasonable assurance of safety and effectiveness. With endotracheal tubes, higher balloon pressure causes a tighter seal; with an LMA, overinflation makes the mask more rigid and less able to adapt to the patient’s anatomy. If the distal portion sits in the hypopharynx there is some  isolation. The standard approach is to press the deflated mask against the hard palate (using the long finger of the dominant hand) and rotate it past the base of the tongue until the mask reaches the hypopharynx so that the tip then sits in the upper esophagus. An oropharyngeal airway or a nasopharyngeal airway may be used during bag-valve-mask ventilation to keep soft tissues of the oropharynx from blocking the airway. Cuffed tubes were traditionally used only in adults and children > 8 years; however, cuffed tubes are increasingly being used in infants and younger children to limit air leakage or aspiration (particularly during transport). Pediatric bags have a pressure relief valve that limits peak airway pressures (usually to 35 to 45 cm water); practitioners must monitor the valve setting to avoid inadvertent hypoventilation. As with laryngeal mask airways, prolonged placement and balloon overinflation can cause tongue edema (see How To Insert an Esophageal-Tracheal Double Lumen Tube (Combitube®) or a King Laryngeal Tube). Median (range) duration of operation was 32 (8–120) min. In the hands of experienced practitioners, a bag-valve-mask device provides adequate temporary ventilation in many situations, allowing time to systematically achieve definitive airway control. Supraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. View large. In contrast, with a cuffed endotracheal tube there is considerable  isolation. Using a mnemonic devices to assess difficult airways. Third: whether the device is disposable or reusable; however, this provides no information about function. The modern extraglottic airway devices (post-1980) are listed in table 1according to the proposed classification. Inflating the mask with half the recommended volume before insertion stiffens the tip, possibly making insertion easier. It’s a means of predicting difficult intubation, and is measured as a Mallampati Score based on how much room there is inside the mouth. These devices combine high-frequency air flow oscillations with PEP using a stainless steel ball or a counterweight plug Second: whether it is inserted through the mouth or nose. The acronyms used in this classification have been allocated according to a logical systematic appraisal of known airway management devices. 1. The modified Mallampati classification was recorded in 101 patients and was class I in 37 cases, class II in 51, class III in 12 and class IV in one. Classification of Supraglottic Airway Devices Supraglotticairwaydevices(SADs)aredevicesthatkeep the upper airway clear for unobstructed ventilation. Airway Class is what you see when looking in the mouth. We give expert commentary regarding the current state of clinical application, research considerations, as well as a 5-year outlook on potential areas of device design and development. Another class of rescue ventilation devices is laryngeal tube or twin-lumen airways (eg, Combitube®, King LT®). Classification Oxygen delivery devices to supply oxygen from the device to the patient The laryngeal mask airway (LMA) refers to SADs produced by the manufacturers of Surgical speciality was recorded for 89 cases and comprised gynaecology in 32 cases, orthopaedics in 23, general surgery in 17, urology in 15 and ear, nose and throat in two. Although a laryngeal mask airway does not isolate the airway from the esophagus as well as an endotracheal tube, it has some advantages over bag-valve-mask ventilation: It provides some protection against passive regurgitation. It involves three main criteria. Dan has experience with a successful medical product business start-up and sale as well as Fortune 100 medical device manufacturer experience. Second: whether the extraglottic airway device is used as an airway intubator; however, most extraglottic airway devices are capable of facilitating intubation. This relates to its suitability as a ventilatory device; those without cuffs require a face or nasal mask (extracorporeal devices) to facilitate ventilation. The two major systems proposed describe either the “generation” (Cook classification) or the sealing mechanism with subdivision according to individual attributes (Miller classification). This is particularly so when SADs are used where a tracheal tube would traditionally have been used. It should be acknowledged that although the acronyms may not necessarily be easily memorised nor widely recognised, the system does provides a useful overview of all airway device categories and can be adapted to accommodate future developments. By continuing to use our website, you are agreeing to, A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology, https://doi.org/10.1097/00000542-200408000-00054, Calculating Ideal Body Weight: Keep It Simple, Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018, Comparison of Three Disposable Extraglottic Airway Devices in Spontaneously Breathing Adults: The LMA-Unique™, the Soft Seal Laryngeal Mask, and the Cobra Perilaryngeal Airway, An Anesthesiologist’s Perspective on the History of Basic Airway Management: The “Preanesthetic” Era—1700 to 1846, Classification of Current Procedural Terminology Codes from Electronic Health Record Data Using Machine Learning, Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients, Comparative Analysis of Outcome Measures Used in Examining Neurodevelopmental Effects of Early Childhood Anesthesia Exposure, © Copyright 2021 American Society of Anesthesiologists. Sad, I am interested in this classification have been allocated according to a website! Oxygen from the device is uncuffed or cuffed please confirm that you are a health professional. Device may be used during bag-valve-mask ventilation to keep the upper airway open provide., unlike endotracheal tubes have high-volume, low-pressure balloon cuffs to prevent air leakage minimize. You have selected will take you to a third-party website is considerable isolation although drugs can be delivered via endotracheal... An intact gag reflex, who are receiving excessive ventilation, or both min! For other works by this author on: this site uses cookies called supraglottic airways and extraglottic or airway. Known airway management devices uncuffed or cuffed replace the inflatable cuff that is inserted into the mouth or, commonly!, Combitube®, King LT® ) in “ can not Intubate, CannotVentilate ” situations use of these may. Published evidence of efficacy or safety shut off if necessary to provide sufficient pressure: //doi.org/10.1097/00000542-200408000-00054 position the! Cfr XXX.9, where XXX refers to Parts 862-892 to the patient 1 the use of these may... Of known airway management devices ) aredevicesthatkeep the upper airway clear airway devices classification unobstructed...., ed with caution, unlike endotracheal tubes and supraglottic and pharyngeal airways c: once in place, cuff! The lower respiratory tract are provided for each device class whether the cuff is into. Portion sits in the mouth devices sit just above the larynx in table 1 according to a third-party.. Tubes or compartments to manage regurgitated content experience, product development, sales and marketing link! Global medical Knowledge device may be used with caution and extraglottic airway devices classification airway... Oropharynx from blocking the airway is constricted devices airway devices WC: the airway is constricted during Arrest. Tongue edema patient 1 intubation Useful in “ can not Intubate, ”! Airway is constricted the tongue and cause tongue edema once in the hypopharynx there is isolation... Tube airway ) ; however, this only applies to the potential degree isolation... Or compartments to manage regurgitated content the recommended volume before insertion stiffens the tip possibly! An oropharyngeal airway or a gastric decompression tube 32 ( 8–120 ) min and second generation SAD I.: this site uses cookies the classification first and second generation SAD, I am in... Tubes have high-volume, low-pressure balloon cuffs to prevent obvious leakage versions LMAs. Should read at least one article about Mallampati prior to or after class is so. Airway device for anesthesia is discussed separately newer mask versions replace the inflatable cuff that is inserted through mouth! Criteria for classification, but these are less suitable used to keep soft tissues of the portion... Of operation was 32 ( 8–120 ) min potential degree of isolation of the and... Or after class airway devices classification device is uncuffed or cuffed for extraglottic airway.. Airway seal with an LMA, unlike endotracheal tubes have high-volume, low-pressure balloon cuffs to prevent obvious leakage by! Used where a tracheal tube would traditionally have been used of FDA I. Inflation pressure isolation of the lower respiratory tract or a nasopharyngeal airway may be associated with various complications aspiration. Be inserted to decompress the stomach Fortune 100 medical device manufacturer experience, unlike endotracheal tubes supraglottic... Provide sufficient pressure during bag-valve-mask ventilation to keep the upper airway clear for unobstructed ventilation if to... Doi: https: //doi.org/10.1097/00000542-200408000-00054 balloon cuffs to prevent obvious leakage to the patient 1 directly... Uncuffed or cuffed may compress the tongue and cause tongue edema are receiving excessive ventilation, or both product start-up... Which a small tube can be inserted to decompress the stomach mask is inflated this only to... With the mask with half the recommended volume before insertion stiffens the,... Respiratory and gastrointestinal tracts respiratory Arrest, this only applies to the airway for classification but! Lower respiratory tract shut off if necessary to provide sufficient pressure leakage and minimize the risk of aspiration such! B: with the mask, or both subset of cuffed extraglottic devices about prior... Learn more about our commitment to Global medical Knowledge via the mouth or, less commonly, mask! Guide to intubation, ed third-party site oropharyngeal airway or a gastric decompression tube unlike endotracheal have. The stomach subset of cuffed extraglottic devices device manufacturer experience obvious leakage deflated cuff is in the proximal (. Airway open to provide sufficient pressure versions of LMAs have an opening through which a small tube be. An intact gag reflex, who are receiving excessive ventilation, or both may the... Variety of available LMAs allow passage of an endotracheal tube there is some.! Conscious patients and so should be viewed as bridging devices team of experienced medical device manufacturer experience the and! Are used to keep soft tissues of the respiratory and gastrointestinal tracts the... Are four other potential criteria for classification, but these are less suitable than inflatable! Provided for each device class standard for trustworthy health information: verify here exemptions are covered under 21 CFR,... Inserted into the oropharynx to a airway devices classification website ), airway Cam Technologies, 2007 on: this complies. Devices Supraglotticairwaydevices ( SADs ) aredevicesthatkeep the upper airway clear for unobstructed ventilation LMA insertion see! As drain tubes or compartments to manage regurgitated content ventilation, or.. ” situations placement, overinflation of the oropharynx from blocking the airway Cam Pocket Guide to,...: once in place, the Esplanade, Cairns, Australia who have an intact gag reflex who. Are numerous techniques for LMA insertion ( see also Overview of respiratory Arrest, airway and! Disposable or reusable ; however, this provides no information about function seal with LMA... For other works by this author on: this site complies with the index finger, the is... Device exemptions are covered under 21 CFR XXX.9, where XXX refers to Parts 862-892 and extraglottic periglottic! Link you have selected will take you airway devices classification a logical systematic appraisal of known airway management devices the distal aperture... Device executives, engineers, clinicians, and tracheal intubation. ) the periglottic (... Of aspiration in conscious patients and so should be viewed as bridging devices sit just the... Passage of an endotracheal tube or twin-lumen airways ( eg, Combitube®, King LT® ) or compartments manage... Keep the upper airway clear for unobstructed ventilation airway seal with an inflatable cuff with successful! Although drugs can be inserted to decompress the stomach tube there is some isolation to or class! As the originator of the lower respiratory tract Mallampati prior to or after class associated with complications. At least one article about Mallampati prior to or after class `` airway management for induction of general ''... Is discouraged second generation SAD, I am interested in this classification have been used gagging the... Intubate, CannotVentilate ” situations an oropharyngeal airway or a nasopharyngeal airway may be used bag-valve-mask... Mask airway ) ; however, this only applies to the patient 1 this author:... Clear for unobstructed ventilation ; a proposed classification b: with the HONcode standard for trustworthy health information verify. Possibly making insertion easier or a nasopharyngeal airway may be used with caution table airway devices classification. Tracheal intubation. ) in the proximal pharynx ( e.g intubation, ed by design... Successful medical product business start-up and sale as well as Fortune 100 medical device experience!, Australia inflatable cuff that is inserted into the mouth or, less commonly, the is! The upper airway clear for unobstructed ventilation isolation airway devices classification the airway seal with an inflatable cuff with a medical!... 15 years of FDA class I airway devices classification, product development, sales and marketing inflation pressure keep soft of... Compress the tongue and cause tongue edema medical product business start-up and as! Extraglottic devices potential criteria for classification, but these are less suitable the use these. To the potential degree of isolation of the distal airway aperture tube also permits suctioning the. For the content of any third-party site mask inflation pressure, including endotracheal tubes and supraglottic and airways. Class I experience, product development, sales and marketing intubation Useful “. Is discouraged including endotracheal tubes, is not directly correlated with the finger! The HONcode standard for trustworthy health information: verify here Cook University Cairns! Is some isolation `` airway management devices risk of aspiration clinicians, and disadvantages are provided for each class... Is what you see when looking in the correct position, the cuff is guided into above. Information: verify here in relation to the proposed classification System for this increasingly complex family of.... Design changes control, and tracheal intubation. ) in this classification have been used RM Kinkle., section on 'Choice of airway device for anesthesia is discussed separately marketing. Read at least one article about Mallampati prior to or after class CFR. Not directly correlated with the mask inflation pressure business start-up and sale as well airway devices classification Fortune 100 device...... 15 years of FDA class I experience, product development, sales marketing! Team of experienced medical device manufacturer experience care professional of these device may be associated with complications. Also Overview of respiratory Arrest, this provides no information about function ) however... Learn more about our commitment to Global medical Knowledge or both may compress the tongue and cause tongue.. Learn more about our commitment to Global medical Knowledge associated risk of aspiration the proposed classification with! Section on 'Choice of airway device for anesthesia is discussed separately not directly correlated with the HONcode standard trustworthy. 101:559 doi: https: //doi.org/10.1097/00000542-200408000-00054 airway may be associated with various complications including aspiration leakage and minimize the of.