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From the Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Address correspondence to: Dr. David T. Wong, Department of Anesthesiology, MC 2–405, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416–603–5118; Fax: 416–603–6494; E-mail: david.wong{at}uhn.on.ca
Purpose: To summarize the published literature related to two, new supraglottic airways (SGAs): the Cobra Perilaryngeal Airway (CobraPLA®) and the Streamlined Liner of Pharyngeal Airway (SLIPATM).
Source: We identified original articles, through searches on Medline and PubMed, using the keywords ‘Cobra’, ‘CobraPLA’, ‘Cobra-PLA’, ‘PLA’, and ‘SLIPA’.
Principal findings: Searches identified 28 publications evaluating the CobraPLA®, six of which were randomized, controlled trials. Five publications evaluated the SLIPATM, two of which were randomized, controlled trials. Studies compared the CobraPLA® with a number of SGAs, in regards to both efficacy and safety. While the CobraPLA® is comparable to the laryngeal mask airway (LMA) ClassicTM, with respect to insertion times and the incidence and severity of sore throat, the CobraPLA® is superior, with respect to airway sealing pressure, and has been used successfully in patients with limited mouth opening and limited head extension. Insertion times, first insertion success rates, recovery times, and hemodynamic responses, associated with insertion of the SLIPATM, are similar to those of the LMA ProsealTM. Although the SLIPATM has a unique reservoir chamber to contain regurgitated fluid, the extent of its protection against pulmonary aspiration has not been established in the clinical setting.
Conclusion: Both the CobraPLA® and the SLIPATM are intended for use during short procedures under general anesthesia, and have comparable efficacy and complication rates in comparison to the LMA ClassicTM. Both airways may be considered as primary SGA devices, and the CobraPLA® may be also be used as a rescue airway device.
1 American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269–77.[Medline]
2 Henderson JJ, Popat MT, Latoo IP, Pearce AC; Difficult Airway Society. Difficult airway society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675–94. 184[Medline]
3 Inoue T. Recent advances in airway management devices (Japanese). Masui 2006; 55: 5–12.[Medline]
4 Crosby E. The unanticipated difficult airway - evolving strategies for successful salvage. Can J Anesth 2005; 52: 562–7.
5 Miller DM. A proposed classification and scoring system for supraglottic sealing airways: a brief review. Anesth Analg 2004; 99: 1553–9.
6 Verghese C, Brimacombe JR. Survey of laryngeal mask airway usage in 11,910 patients: safety and efficacy for conventional and nonconventional usage. Anesth Analg 1996, 82: 129–33.[Abstract]
7 Miller DM, Youkhana I, Karunaratne WU, Pearce A. Presence of protein deposits on ‘cleaned’ re-usable anaesthetic equipment. Anesthesia 2001; 56: 1069–72.[Medline]
8 Rich JM, Mason AM, Bey TA, Krafft, Frass M. The critical airway, rescue ventilation, and the combitube: Part 1. AANA J 2004; 72: 17–27.[Medline]
9 Asai T, Shingu K. The laryngeal tube. Br J Anaesth 2005; 95: 729–36.
10 Hung O, Law JA. Advances in airway management. Can J Anesth 2006; 53: 628–31.
11 Brimacombe J. A proposed classification system for extraglottic airway devices. Anesthesiology 2004; 101: 559.[Medline]
12 Wadhwa A, Sessler DI, Sengupta P, Hanni K, Akca O. Core temperature measurements through a new airway device, perilaryngeal airway (CobraPLA). J Clin Anesth 2005; 17: 358–62.[Medline]
13 Quinn B. The CobraPLA - a response from the manufacturer. Anaesthesia 2005; 60: 817–8.[Medline]
14 Cook TM, Lowe J. More on the CobraPLA. Anaesthesia 2005; 60: 1144–5.[Medline]
15 Alfery DD, Ghelber Ezri T, Szmuk P. Correct sizing of the CobraPLA is necessary for valid study results. Eur J Anaesthesiol 2006; 23: 714–5.[Medline]
16 Alfery D, Ezri T, Ghelber O, Szmuk P. Teaching airway management is dependent on the knowledge of the teachers. Acta Anaesthesiol Scand 2006; 50: 895–6.[Medline]
17 van Zundert A, Al-Shaikh B, Brimacombe J, Koster J, Koning D, Mortier EP. Comparison of the three disposable extraglottic airway devices in spontaneously breathing adults: the LMA-Unique, the Soft Seal laryngeal mask, and the Cobra perilaryngeal airway. Anesthesiology 2006; 104: 1165–9.[Medline]
18 Kurola J, Pere P, Neimi-Murola L, et al. Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients. Acta Anaesthesiol Scand 2006; 50: 40–4.[Medline]
19 Gaitini L, Yanovski B, Somri M, Vaida S, Riad T, Alfery D. a comparison between the PLA Cobra and the Laryngeal Mask Airway Unique during spontaneous ventilation: a randomized prospective study. Anesth Analg 2006; 102: 631–6.
20 Turan A, Kaya G, Koyuncu O, Karamanlioglu B, Pamukcu Z. Comparison of the laryngeal mask (LMA) and laryngeal tube LT (LT) with the new perilaryngeal airway (CobraPLA) in short surgical procedures. Eur J Anaesthesiol 2006; 23: 234–8.[Medline]
21 Akca O, Wadhwa A, Sengupta P, et al. The new perilaryngeal airway (Cobra PLA) is as efficient as the laryngeal mask airway (LMA) but provides better airway sealing pressures. Anesth Analg 2004; 99: 272–8.
22 Gaitini LA, Somri M.J, Kersh K, Yanovski B, Vaida S. A comparison of the Laryngeal Mask Airway UniqueTM, Pharyngeal Airway X pressTM and Perilaryngeal Airway CobraTM in paralyzed anesthetized adult patients. Anesthesiology 2003; 99: A1495 (abstract).
23 Agro F, Barzoi G, Carassiti M, Galli B. Getting the tube in the oesophagus and oxygen in the trachea: preliminary results with the new supraglottic device (Cobra) in 28 anaesthetised patients. Anaesthesia 2003; 58: 920–1.[Medline]
24 Agro F, Carassiti M, Magnani C, Alfery D. Airway control via the CobraPLA during percutaneous dilatational tracheostomy in five patients. Can J Anesth 2005; 52: 418–20.
25 Agro F, Carassiti M, Magnani C. Percutaneous dilatational cricothyroidotomy: airway control via CobraPLA. Anesth Analg 2004; 99: 628.
26 Khan RM, Maroof M, Johri A, Ashraf M, Jain D. Cobra PLA can overcome LMA failure in patients with face and neck contractures. Can J Anesth 2005; 52: 340.
27 Dimitriou V, Brimacombe J, Zogogiannis I, Voukena V, Malefaki A, Voyagis GS. Success of the Cobra after failure of the Fastrach in the difficult airway. Can J Anesth 2005; 52: 992.
28 Szmuk P, Ezri T, Akca O, Alfery DD . Use of a new supraglottic airway device - the CobraPLA - in a ‘difficult to intubate/difficult to ventilate’ scenario. Acta Anaesthesiol Scand 2005; 49: 421–3.[Medline]
29 Szmuk P, Matuszczeak M, Carlson RF, Warters RD, Rabb MF, Ezri T. Use of CobraPLA for airway management in a neonate with Desbuquois syndrome. Case report and anesthetic implications. Paediatr Anaesth 2005; 15: 602–5.[Medline]
30 Cook TM. Use of the CobraPLA for percutaneous cricothyroidotomy and tracheostomy. Anesth Analg 2005; 100: 902.
31 Agro F, Carassiti M, Mangani C. Use of the CobraPLA for percutaneous cricothyroidotomy and tracheostomy. Anesth Analg 2005; 100: 902–3.
32 Szmuk P, Ghelber O, Akca O, Ezri T. CobraPLA as a conduit for flexible bronchoscopy in a child under general anaesthesia. Br J Anaesth 2005; 94: 548–9.
33 Cook TM, Lowe JM. An evaluation of the Cobra perilaryngeal airway: study halted after two cases of pulmonary aspiration. Anaesthesia 2005; 60: 791–6.[Medline]
34 Farrow C, Cook T. Pulmonary aspiration through a Cobra PLA. Anaesthesia 2004; 59: 1140–1.[Medline]
35 Yamaguchi S, Urabe K, Ikeda T, Kitajima T. Airway obstruction due to incarceration of the epiglottis into the epiglottic bars during general anesthesia with a new perilaryngeal airway (CobraPLA). Anesth Analg 2006; 102: 973.
36 van Zundert A, Baha AS, Brimacombe J, Mortier E. Valve leaks with new disposable extraglottic airway devices. Anesthesiology 2005; 103: 213.[Medline]
37 Quinn B. Valve leaks with new disposable extraglottic airway devices. Anesthesiology 2003; 103: 214.
38 Miller DM, Lavelle M. A streamlined pharynx airway liner: a pilot study in 22 patients in controlled and spontaneous ventilation. Anesth Analg 2002; 94: 759– 61.
39 Hein C, Plummer J, Owen H. Evaluation of the SLIPA (Streamlined liner of the pharynx airway), a single use supraglottic airway device, in 60 anaesthetized patients undergoing minor surgical procedures. Anaesthesia and intensive care 2005: 33: 756–61.[Medline]
40 Miller DM, Camporota L. Advantages of Proseal and SLIPA airways over tracheal tubes for gynecological laparoscopies. Can J Anesth 2006; 53: 188–93.
41 Miller DM, Light D. Laboratory and clinical comparisons of the Streamlined Liner of the Pharynx Airway (SLIPA) with the laryngeal mask airway. Anaesthesia 2003; 58: 136–42.[Medline]
42 Coetzee GJ. Flow through disposable alternatives to the laryngeal mask. Anaesthesia 2003; 58: 280–1.[Medline]
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