Cite this post as:
Scott Weingart, MD FCCM. StaS Maneuver: Changing out a Non-Intubating Laryngeal Airway. EMCrit Blog. Published on September 30, 2016. Accessed on April 19th 2024. Available at [https://emcrit.org/emcrit/stas-maneuver-changing-non-intubating-laryngeal-airway/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: September 30, 2016
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Scott, Will & Erik, thanks for the concept & video – a simple, elegant solution achieved by challenging the “mental frame” that you can’t destroy the equipment. Disposable scopes have changed the game! I think it’s important to recognise though, that what this technique sacrifices versus the use of an Aintree catheter (https://www.das.uk.com/files/AIC_abbreviated_Guide_Final_for_DAS.pdf) is the ability to ventilate via the “exchange device” (either the Aintree catheter or severed A-scope) in the event that the ETT cannot be railroaded into the trachea. While demonstrated here in an elective setting, the likely utility of this technique would be in the situation of… Read more »
Nick, mate, no one is suggesting STaS technique is a routine replacement/alternative to Aintree catheter!
Hi Minh. My concern was that the original version of the opening notes (and the one to which I responded) stated that StaS “obviated the need” for the Aintree, which may inadvertently have implied exactly that.
I note that this has now been altered (thanks Scott!). The current updated statement to the effect that it circumvents the absence of the Aintree I think more accurately contextualises the role of StaS in airway exchange. No denying this can be a useful technique in the right circumstances.
yep, it is much clearer with the way currently worded that this is for when you don’t have the ideal equipment rather than being a new equivalent technique
The patient should be fully pre/reoxygentated by the SGA before even passing the aScope. If for some reason the tube won’t advance, the tube should be removed and the sga reinserted over the cut ascope which will guide it to its former position. A bronch port should be place over the cut ascope allowing oxygenation with it in situ. Then after reoxygenation, further attempts can be made. Reliance on the Aintree for an exchange catheter for reoxygenation is suboptimal without some form of jet ventilation through it, even then it is suboptimal due to the risks of pressure injury to… Read more »
Thanks Scott. I agree that those are valid techniques but this still carries with it the small additional risk that railroading of devices (either the ETT or replacing the SGA over the severed A-scope) will fail. I’m not sure what is being gained in exchange for this risk. My experience is that having any kind of exchange device in the tracheal lumen should never be considered a guarantee that an ETT will be able to be delivered to the trachea (or an SGA to the glottis). In addition to an ETT “hanging up” at the glottis (which can often, but… Read more »
Nick, others have stated the why. Equipment availability is the why. If you have an aintree and scope to fit it–of course use it. The answer-“so get one” seems to ignore some fundamental workings of hospitals.
Agree completely!
I wanted to inform readers that this technique has been described before in 2012
A potential technique for flexible scope-assisted intubation using an Ambu aScope 2 inserted via a supraglottic airway device. Chatterjee J,Reid C , Lewis A. Anaesth Intensive Care. 2012 Jul;40(4):724.
Love the technique, and I like the clever acronym, though at some point Ambu will have competition in the disposable scope market, at which time this acronym will have some commercial bias. Just sayin’. Nevertheless, thanks for sharing!
yep, StdS with d for disposable would be even better-but not my maneuver
s
The time has come. GlideScope has the BFlex, and with the Core monitors, you can do VL and SU bronch simultaneously.
We keep a long flexible guidewire on the bronch cart for this reason (Boston Sci 180 cm Jagwire, and no, I don’t get any money from them). It can go through the working channel of most bronchoscopes so you don’t run into the compatibility or availability issue with the Aintree. Of course, you do need an intubating bougie or airway exchange catheter that has a channel like the Cook catheter or Frova (again, no money). Those the advantage of being able to connect an adapter to oxygenate through in case the ET tube won’t pass. I’ve used this through both… Read more »
Nice to see this technique getting out there and some helpful discussion around it. At Sydney HEMS we don’t carry an Aintree but we do have the aScope, so we came up with this idea a few years ago.For the historical record (because I know you care about these things) I thought of it and our Airway expert Anthony Lewis tested it with John Chatterjee.We published a training video for our team in June 2012 and, as Minh says, we published the idea in July 2012 in this letter.Yen Chow tested it out and also sent me a video of Jim… Read more »
love it! Thanks for setting the record straight Cliff!!
Late comer to this discussion – but pertinent because often discuss this on Chris Nickson’s ‘critically ill airway’ course Whilst Aintree change is God Standard, these are often not available in ED or rural/remote I hear Nick’s concerns re maintaining oxygenation. With is why I’m a fan of the combination of the ‘resuscitation’ iGel pack – this has an additional port for O2 insufflation. Looping and Ascope dislodgement is always a risk – but the alternative is perhaps worse. Would be interested in the SydneyHEMS experience – been 5 years or so since the ‘cut Ascope’ technique was described online… Read more »