Anesthesiology/Supraglottic Airways


Which of the following devices do you prefer for use in a difficult airway and why? LMA Supreme, I-gel Intersurgical, Ambu, King LTDS, Vital Signs, etc.

Hi Heather

Thanks for the question!

Well, the best answer is "it depends".

Do you want to know what i would use AFTER an intubation attempt that failed? Or do you want to know what i would use on a patient who 'might' be a difficult airway and would be a candidate for a supraglottic device based on the operation anyway?

If it was after a failed intubation attempt the answer would be non of these. I use an Intubating LMA. That way i can place the LMA to ventilate then attempt to pass a ETT through it resulting in a definitive airway. In the operating room if the case called for an intubation in the first place it often cannot be done with a supraglottic device.

If it was a case which would normally be done with a supraglottic airway and I felt this would be a "difficult airway" I would try and do the case with a regional anesthetic like a block or a spinal. That way I would not have to worry about the airway. For example, I may normally use a supraglottic device in a urology case but if i thought it would be a difficult airway, like a morbidly obese patient with a short neck, i would do it under spinal.

If it was not a case which I could do under a regional anesthetic then I would have a video laryngoscope in the room for backup and pick a supraglottic device which seemed most appropriate. Often we are limited by what the facility stocks and in my case that would LMA and LMA supremes. I like them because they are designed for PPV use and have an integrated drain tube to prevent aspiration. Having said that I think the LMA supreme is excellent for these types of patients.

As for the other devices you mentioned, the King LT is more of a pre-hospital device not used in the operating room. I used it and combitubes when i was a flight RN and they are excellent when intubation fails. The igel is a nice device for the typical case which requires a supraglottic airway but in my opinion it isnt the first line for a suspected difficult airway. The ambu is similar to the typical LMA and again not my first choice for difficult airway. I am not familiar with the vital signs device.

Hope this helps!  


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Mike MacKinnon MSN FNP-C CRNA


I am a former Trauma Flight RN now a Family Nurse Practitioner and a Nurse Anesthetist (CRNAs). I can help answer questions on the CRNA profession and clinical anesthesia. I work full time as an independent practice CRNA and have a special interest in regional anesthesia, particularly peripheral nerve blocks. I also teach ultrasound regional anesthesia and lecture all over the country. If I do not know the answer, I will find it for you.


I am a Family Nurse Practitioner and a Nurse Anesthetist who works as an independent/autonomous practitioner. There are often questions about my profession and I would like to offer the service of an actual CRNA. If you did not know, there are about 40000 of us which equates to 50% of the anesthesia providers in the USA today. I also lecture and teach ultrasound regional anesthesia all over the country.

AANA (American Association of Nurse Anesthetists)
IARS (International Anesthesia Research Society) AANP (American Association of Nurse Practitioners)

Air Medical Transport Journal
OutPatient Surgery Magazine

Bachelors of Science in Nursing
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Excellence in anesthesia education award

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