When To Specify A Reinforced Airway Device

What Reinforcement Means Physically

A reinforcing spiral runs within the wall of the entire tube. The tube stays flexible, but it will not flatten and occlude when it is bent, compressed or pressed on. On a laryngeal mask the same idea is applied to the airway tube rather than the cuff.

The Procedures Where It Pays

Anything that moves the head after the airway is placed, or puts drapes and retractors over the tube. ENT, dental and maxillofacial surgery, neurosurgery, and any prone positioning. In those cases a standard tube can kink at a point the anaesthetist cannot see, and the first sign is a ventilation problem.

The Procedures Where It Does Not

Routine supine general anaesthesia with the head in a neutral position does not stress the tube. Specifying reinforced tubes across a whole theatre list raises cost without changing outcomes, which is why most departments hold them as a separate stock line rather than a default.

Insertion Is Different

A reinforced tube is more flexible than a standard one, which makes it harder to direct. Use a stylet on insertion. This is a practical difference that catches out staff moving between the two lines, so it belongs in the handover when a new stock line is introduced.

Cuffed Or Uncuffed Still Applies

Reinforcement and cuffing are independent decisions. Reinforced tubes are available cuffed for positive pressure sealing and uncuffed where a cuff would press on a narrow paediatric airway. Both run sizes 3 to 10.