TROUBLESHOOTING SUPRAGLOTTIC AIRWAY INSERTION

As with the other lifelines, interventions to optimize attempts at achieving alveolar oxygen delivery via a supraglottic airway should be targeted towards the factors impeding success. The challenges arising with supraglottic airway insertion can be categorised under three headings:

1. Entry: inability to insert the supraglottic airway into the mouth due to factors such as limited mouth opening or excessive muscle tone. 
2. Passage: difficulties in getting the supraglottic airway to negotiate the pathway through the pharynx to reach the larynx.
3. Seating: misalignment of the laryngeal orifice and the laryngeal inlet (leading to obstruction or gastric insufflation) or inadequate seal of the cuff of the supraglottic around the laryngeal orifice (leading to leak around the cuff and inability to generate sufficient pressure to allow alveolar ventilation).

From the Vortex Approach – Supraglottic Airway Optimization