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A1099
October 24, 2015
10:00:00 AM - 12:00:00 PM
Room Hall B2-Area B
Use of the Jaw Elevation Device in Deep Sedation
Erik E. Davila-Moriel, M.D., Judd A. Whiting, M.D.
Naval Medical Center San Diego, San Diego, California, United States
Disclosures: E.E. Davila-Moriel: None. J.A. Whiting: None.
Introduction : Maintaining a patent airway is a constant concern to

anesthesia providers performing deep sedation cases. The doses of medications often required for

the desired level of sedation frequently result in airway occlusion and apnea. Opening the occluded airway requires the use

of an invasive airway device, (e.g Intubation, laryngeal mask airway, oral

airway or nasal airway) or the application of a jaw thrust maneuver. When the provider releases the jaw thrust to

attend to other anesthetic and monitoring duties, the patient may not have

adequate ventilation and the patient’s oxygen saturation can fall producing

hypoxemia. Airway management devices currently available require deeper levels

of sedation to be tolerated by patients. To avoid the need for internal airway

devices, providers attempt to carefully adjust the level of sedation so that no

airway support is required. Unfortunately, this often results in an

uncomfortable patient or one who is moving too much to successfully carry out

the procedure. The Jaw Elevation Device

(JED) is an external device that is designed to assist providers in maintaining

a patent airway. By duplicating the jaw

thrust maneuver, the JED maintains a patent airway, allowing anesthesia

providers to attend to other duties associated with anesthesia administration

in a hands free manner during moderate and deep sedation.

Study

Method
: Our study involves the

observation of the JED being used during deep sedation cases in adult female

patients undergoing egg retrieval for infertility. IRB approval was obtained to enroll 50

patients for an observational prospective study. The anesthesia provider for

each case was allowed to choose the anesthetic technique based on their

clinical judgment. If the patient became apneic, a jaw thrust was performed to

relieve the obstruction followed by immediate placement of the JED. Data points observed included: sedation

length, medications used, time until obstruction, success of JED placement, duration

of JED use, number of JED adjustments after placement, use of additional airway

devices, and conversion to general anesthesia.

Results : Of the 50 patients

enrolled, 31 patient’s airway obstructed.

The JED was used in 28 cases of these cases. 8 of the 28 cases utilizing the JED required

additional airway adjustment (28.5%). An

average of one adjustment was required after JED placement. One case required the use of an additional

airway device, and no cases converted to general anesthesia (LMA/ET

intubation).

Conclusion : It appears that the JED

is a useful airway adjunct that successfully maintains a patent airway during

deep sedation with minimal additional input for the anesthesia provider. The JED requires minimal additional

adjustment, freeing the anesthesia provider to attend to other patient needs

during the cases. Further study is

needed before any generalizable conclusions or comparisons to other airway

devices can be made.


Copyright © 2015 American Society of Anesthesiologists