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 Methods Discussion

•Lasermark on VAMA allowed clinician to

•Valentin Andres Madrid Airway (VAMA) is a Figure 1- Picture of VAMA with different views showing detachable piece and
orient FFB
lasermark
new intubating airway •Detachable piece of airway facilitated removal
•New design features of VAMA facilitate FFB of VAMA without accidental ETT removal
intubation •Intubating patient with VAMA •Further research required using VAMA in
•We present our initial experience using VAMA •Several views patients with difficult airways
airway –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]
Abstract

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

Authors: Marzal Patricia, Llobell Francisca, Cardona Juan, Madrid Andres, Madrid Valentin, Bryan
Yvon
Methods Results 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
•19 patients underwent FFB using VAMA •Age (mean and range) = 57.5 years (31-86) 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

•Awake/sedation with topical anesthesia or general •Time to intubation (mean,range) = 42 seconds avoiding interruption in ventilation and inadvertent extubation. We describe our experience with the
VAMA® intubating airway for fiberoptic intubation.

anesthesia (25-70) Methods

•Lasermark of VAMA facilitates orientation •Visualization of glottic opening on initial FFB 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
introduction = 13/19 (68%) patients fiberscope was loaded with an ETT and placed orally via the VAMA® airway. Using lasermark on the
•Detachable piece facilitates removal of VAMA 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.
•Chin lift required for exposure of glottic opening
airway while ETT remains connected The detachable piece of the VAMA® was first removed and while holding the ETT, the remaining part

= 6/19 (32%) patients of the VAMA® airway was removed without disconnecting the ETT from circuit.

•Removal of VAMA does not interrupt ventilation or •Intubations on first attempt (one patient required Results

risk inadvertent extubation 3 attempts) = 18/19 (95%) patients 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
•5 patients with known difficult airways 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
•7 intubations performed awake/sedation, 7 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.
intubations using paralytics 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