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GENERAL ARTICLES

A Comparison of the PAxpress^TM and Face Mask Plus Guedel Airway by Inexperienced Personnel After Mannequin-Only Training

V. Dimitriou, MD DEAA^*, G. S. Voyagis, MD, C. Iatrou, MD^*, and J. Brimacombe, MB ChB, FRCA, MD

*Department of Anaesthesia, University of Thrace; Department of Anaesthesia, Sotiria Hospital, Greece; and Department of Anaesthesia and Intensive Care, University of Queensland and James Cook University, Cairns Base Hospital, Australia

Address correspondence and reprint requests to J. Brimacombe, MD, Department of Anesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to jbrimacombe{at}austarnet.com.au

The PAxpress^TM (PAX) is a new extraglottic airway device consisting of an anatomically curved tube, an inflatable circular cuff in the midsection, a noninflatable gilled conical cuff at the distal end, and an anterior-facing, rectangular hooded vent between the two cuffs. We compared the ability of nurses with no previous airway management experience to ventilate the lungs of 45 ASA physical status I and II anesthetized, paralyzed patients using either the PAX or face mask and Guedel airway (FM/GA) after mannequin-only training. Nurses were asked to ventilate the patient to an expired target tidal volume of 7 mL/kg and then to the maximum tidal volume achievable. The FM/GA was used first and the then the PAX. The target tidal volume was achieved in all patients with both devices. There were no differences in the time taken (PAX, 41 ± 15 s; FM/GA, 39 ± 25 s) or the number of insertion attempts to achieve the target tidal volume. There were no differences in the frequency of esophageal leaks at the target (PAX, 9%; FM/GA, 4%) and maximum tidal volume (PAX, 51%; FM/GA, 49%). The maximal tidal volume (1261 ± 306 versus 958 ± 220 mL; P < 0.0001) and peak airway pressure (37 ± 5 versus 28 ± 6 cm H₂O; P < 0.0001) was larger for the PAX, but blood was detected more frequently (22% versus 0%; P = 0.001). We conclude that ventilation to a target tidal volume of 7 mL/kg in anesthetized, paralyzed adults is equally successful for the PAX and FM/GA by inexperienced nurses after mannequin-only training. However, the maximal tidal volume and peak airway pressure is larger and airway trauma more common with the PAX.

IMPLICATIONS: Ventilation to a target tidal volume of 7 mL/kg in anesthetized, paralyzed adults is equally successful for the PAxpress^TM (PAX) and Face Mask/Guedel Airway by inexperienced nurses after mannequin-only training. However, the maximal tidal volume and peak airway pressure is larger and airway trauma more common with the PAX.