The PAxpress(TM) is an effective ventilatory device but has an 18% failure rate for flexible lightwand-guided tracheal intubation in anesthetized paralyzed patients: (Le PAxpress(TM) est un appareil de ventilation efficace, mais presente un taux d'ec

摘要

PURPOSE: The PAxpress(TM) is a new, single-use, extraglottic airway device. We evaluate: 1) insertion success rates; 2) airway sealing pressure, ventilatory capability and calculated mucosal pressures (in vitro minus in vivo intracuff pressure) at 30-60 mL cuff inflation volume; 3) the feasibility of lightwand-guided tracheal intubation; and 4) the incidence of mucosal trauma. METHODS: Ninety anesthetized, paralyzed adults were studied. Airway management was by senior anesthesiologists with no prior experience with the PAX, but considerable experience with extraglottic airway devices and the flexible-lightwand. RESULTS: Insertion was successful at the first attempt in 95.5% (86/90) and at the second attempt in 4.5% (4/90). Mean +/- SD airway sealing pressure at 30, 40, 50 and 60 mL cuff inflation volume was 27 +/- 8, 29 +/- 9, 32 +/- 9 and 35 +/- 7 cm H(2)O respectively; expired tidal volume at airway sealing pressure was 16 +/- 6, 18 +/- 6, 19 +/- 5 and 19 +/- 6 mL*kg(-1); and calculated mucosal pressure was 38 +/- 14, 55 +/- 20, 56 +/- 19 and 57 +/- 20 cm H(2)O. Airway sealing pressure, expired tidal volume at airway sealing pressure and calculated mucosal pressures increased with cuff inflation volume (all: P /= 35 cm H(2)O and cuff inflation volumes >/= 40 mL. Lightwand-guided intubation was successful in 82% (74/90) of patients. Mild, moderate and severe blood staining was detected in 40% (36/90), 15% (13/90) and 1% (1/90) respectively. Blood staining was more frequent after adjusting maneuvers (22/54 vs 32/36, P = 0.002). CONCLUSION: The PAX has a high insertion success rate and is an effective ventilatory device with a low risk of gastric insufflation, but has a moderately high failure rate for lightwand-guided intubation and is associated with a relatively high incidence of mucosal trauma. Mucosal pressures may exceed pharyngeal perfusion pressure.