Vama Poster2

The new VAMA® intubating airway: a unique design for fiberoptic intubation Patricia Marzal, M.D.1, Francisca Llobell, M.D.1, Juan Cardona, M.D.1, Andres Madrid1, Valentin Madrid, M.D.1, Yvon F. Bryan, M.D.2* 1.Hospital G. U. Marina Alta, Denia (Alicante), Spain 2. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Introduction •Valentin Andres Madrid Airway (VAMA) is a new intubating airway •New design features of VAMA facilitate FFB intubation •We present our initial experience using VAMA airway

Discussion

Methods Figure 1- Picture of VAMA with different views showing detachable piece and lasermark

•Intubating patient with VAMA •Several views –Insertion of VAMA alone in mouth –FFB with ETT via VAMA –Removal of detachable piece (pestana) –Removal of entire VAMA –[4 views displayed in quadrant form]

•Lasermark on VAMA allowed clinician to orient FFB •Detachable piece of airway facilitated removal of VAMA without accidental ETT removal •Further research required using VAMA in patients with difficult airways

Abstract Title: The new VAMA® intubating airway: a unique design for fiberoptic intubation

Methods •19 patients underwent FFB using VAMA •Awake/sedation with topical anesthesia or general anesthesia •Lasermark of VAMA facilitates orientation •Detachable piece facilitates removal of VAMA airway while ETT remains connected •Removal of VAMA does not interrupt ventilation or risk inadvertent extubation

Results •Age (mean and range) = 57.5 years (31-86) •Time to intubation (mean,range) = 42 seconds (25-70) •Visualization of glottic opening on initial FFB introduction = 13/19 (68%) patients •Chin lift required for exposure of glottic opening = 6/19 (32%) patients •Intubations on first attempt (one patient required 3 attempts) = 18/19 (95%) patients •5 patients with known difficult airways •7 intubations performed awake/sedation, 7 intubations using paralytics

Authors: Marzal Patricia, Llobell Francisca, Cardona Juan, Madrid Andres, Madrid Valentin, Bryan Yvon Introduction Several available intubating airways facilitate performing fiberoptic intubation and placing an endotracheal tube (1,2). The new VAMA intubating airway incorporates design features which address common problems encountered during fiberoptic intubation. A line with an arrow (lasermark) embedded on the distal part of the ventral surface of the posterior portion of the airway facilitates orientation (see Figure 1). A detachable piece on the proximal portion of the airway facilitates removing the VAMA airway while the endotracheal tube (ETT) remains connected to the circuit; thus avoiding interruption in ventilation and inadvertent extubation. We describe our experience with the VAMA® intubating airway for fiberoptic intubation. Methods After obtaining verbal consent, 19 patients undergoing surgery and requiring endotracheal (ETT) intubation were recruited. After general anesthesia or sedation and topical anesthesia, a 5.5 mm flexible fiberscope was loaded with an ETT and placed orally via the VAMA® airway. Using lasermark on the VAMA® for guidance, the FFB was inserted until the glottic opening was visible. After advancing the FFB through the vocal chords, the ETT was railroaded into the trachea and the position was confirmed. The detachable piece of the VAMA® was first removed and while holding the ETT, the remaining part of the VAMA® airway was removed without disconnecting the ETT from circuit. Results The mean and range of age and time to intubation were 57.5 years (31-86) and 42 seconds (25-70). In 13 patients, the glottic opening was visualized on first pass of the FFB placed in the VAMA® airway. In 6 patients, a chin lift exposed the glottic opening. All intubations occurred on first attempt, except one which required three attempts. Five patients had known difficult airways (DA), 7 intubations were awake and in 7 patients, paralytic agents were used. Discussion The lasermark of the VAMA® airway helps identify the anatomical landmarks necessary for fiberoptic intubation. Disconnecting the removable piece facilitates complete removal of the VAMA® airway. Further research is required comparing to other intubating airways in patients with known DA’s who are both awake and anesthetized. References 1) J Clin Anesth 2004 16:66-73. 2) Anaesth 2004 59: 173–176. 3) VAMA Canula Package Insert www.ajlsa.com

*Wake Forest University Baptist Medical Center