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A782
October 14, 2012
1:00:00 PM - 4:00:00 PM
Room Hall C-Area H
Effectiveness of the Jaw Elevation Device in Prevention of Desaturation During Sedation and Monitored Anesthesia Care: A Prospective QA Audit
John Narron, M.D., Priti Dalal, M.D.,F.R.C.A, Padmani Dhar, M.D., Arne Budde, M.D., Sonia Vaida, M.D.
Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
Introduction: Patients undergoing sedation and monitored anesthesia care for diagnostic or therapeutic procedures are at a risk of airway obstruction. This may be managed with the help of a manual ‘jaw thrust’ maneuver applied by the provider (1, 2). However, application of this maneuver may be limited by competition for space where procedure may be performed on the head or the neck, field avoidance such as in case of MRI scanning and radiological procedures and finally fatigue on the part of the provider. This problem may be alleviated by the use of a jaw elevation device (JED). The JED is FDA approved external airway device that enables the clinician to provide a jaw thrust in order to maintain an open airway during any procedure in which a patient is sedated and the airway may be compromised. Use of this device is gaining popularity at our institute, especially for offsite and operating room procedures sedation procedures. However, formal studies on this device are lacking in the research literature.

The aim of this quality assurance (QA) study was to determine the safety and efficacy of the JED and determine its use in sedation procedures in our setting.

Method: Following IRB approval (determined as IRB exempt) we prospectively collected data on the use of the JED in case of 10 consecutive patients where this device was used at the discretion of the attending anesthesiologist. The primary outcome variables were (1) the occurrence of desaturation and (2) the need to convert to an LMA (laryngeal mask airway) or ETT (endotracheal tube). Data Collected included age, weight, height, BMI, occurrence of desaturation, use of rescue mechanisms and airway interventions.

Results: The mean age of the patients was 61.3 (± 19.76) years, mean weight 77.04 kg (±24.74), BMI 26.63 (±5.48). The type of procedures included plastics, orthopaedics, vascular, and radiology, with the majority of our patients (7) being from radiology (MRI studies). The mean duration of procedure was 103.50 min (± 48.59). Desaturation was reported in 10% of patients. The noted rescue mechanisms used in case of desaturation were adjustment of the JED or use of oropharyngeal airway in the study subjects. None of our patients required conversion to LMA or ETT. There were no complications noted in the recovery period.

Conclusion: The JED™ is a non-invasive device that maintains a patent airway in patients receiving sedation. The JED™ eliminates or minimizes the need for external manipulation (jaw thrust) or use of upper airway devices such as oropharyngeal airway, nasopharyngeal airway or more definitive airway devices such as LMA or ETT. Perhaps, the JED may be suitable for maintenance of the airway in adult patients undergoing diagnostic or therapeutic procedures under sedation. Randomized controlled studies to assess the efficacy of this device are justified.

References:



  1. McGrane O et al. Procedural sedation with propofol: a retrospective review of the experiences of an emergency medicine residency program 2005 to 2010 Am J Emerg Med.2011. Article in press


  2. Arepally A et al. Safety of conscious sedation in interventional radiology. Cardiovasc Intervent Radiol. 2001;24(3):185-90.




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