11
en
• If you cannot open the patient’s mouth sufficiently to
insert the mask, check that the patient is adequately
anesthetized. Ask an assistant to pull the jaw
downwards thus making it easier to see into the mouth
and verify the position of the mask.
• For difficulty in maneuvering the angle at the back of
the tongue when inserting Aura-i, press the tip against
the palate throughout or else the tip may fold on itself
or meet an irregularity in the posterior pharynx, e.g.,
hypertrophied tonsils. Should the cuff fail to flatten
or begin to curl over as it is inserted, withdraw the
mask and reinsert it. In case of tonsillar obstruction, a
diagonal movement of the mask is recommended.
3.4. Fixation
If deemed necessary, secure Aura-i to the patient’s face
with adhesive tape or with a mechanical tube holder suited
for this purpose.
7
It is recommended to use a gauze
bite block.
3.5. Inflation
• Without holding the tube, inflate the cuff with just
enough air to obtain a seal, equivalent to intracuff
pressures of a maximum of 60 cmH
2
O.
6
Often only half
of the maximum volume is sufficient to achieve a seal –
please refer to Table 1 for maximum intracuff volumes.
• Monitor the cuff pressure continuously during the
surgical procedure with a cuff pressure gauge. This is
especially important during prolonged use or when
nitrous gases are used.
• Look for the following signs of correct placement: The
possible slight outward movement of the tube upon
cuff inflation, the presence of a smooth oval swelling in
the neck around the thyroid and cricoid area, or no cuff
visible in the oral cavity.
• The mask may leak slightly for the first three or four
breaths before settling into position in the pharynx.
In case leakage persists, check that there is adequate
depth of anesthesia and that the pulmonary inflation
pressures are low before assuming that reinsertion of
Aura-i is necessary.
3.6. Verification of correct position
• Correct placement should produce a leak-free seal
against the glottis with the tip of the cuff at the upper
oesophageal sphincter.
• The vertical line on the connector shell should be
oriented anteriorly towards the patient’s nose.
• Aura-i is inserted correctly when the patient’s incisors
are between the normal depth of insertion marks
(the two horizontal lines) on the connector shell.
2
,
item 5. Reposition the mask if the patient’s incisors are
outside this range.
• The position of Aura-i can be assessed by capnography,
by observation of changes in tidal volume (e.g., a
reduction in expired tidal volume), by auscultating
bilateral breath sounds and an absence of sounds
over the epigastrium and/or by observing chest rise
with ventilation. If you suspect that Aura-i has been
positioned incorrectly, remove and reinsert –
and ensure that anesthetic depth is adequate.
• Visual confirmation of anatomically correct position is
recommended, e.g., by using a flexible scope.
UNEXPECTED REGURGITATION:
• Regurgitation may be caused by inadequate level of
anesthesia. The first signs of regurgitation may be
spontaneous breathing, coughing or breath-holding.
• If regurgitation occurs, if oxygen saturation remains
at acceptable levels, Aura-i should not be removed.
This should be managed by putting the patient in a
“head-down” position. Briefly disconnect the anesthetic
circuit so that the gastric contents are not forced into
the lungs. Check that anesthetic depth is adequate and
deepen anesthesia intravenously, if appropriate.
• Apply suction through the mask’s patient tube and
through the mouth. Suction the tracheobronchial tree
and inspect the bronchi using a flexible scope.
3.7. Usage with other devices/equipment
ANESTHETIC SYSTEM AND VENTILATION BAG
The mask can be used for either spontaneous or
controlled ventilation.
During anesthesia, nitrous oxide may diffuse into the
cuff causing an increase in cuff volume/pressure. Adjust
cuff pressure just enough to obtain an adequate seal
(cuff pressure should not exceed 60 cmH
2
O).
