AANA Journal, April 2024

Oropharyngeal airways (OPA) or nasopharyngeal airways (NPA) sometimes require chin-lift or jaw-thrust (CLJT) maneuvers to relieve airway obstruction, which necessitates continuous hands-on care by anesthesia providers. A new distal pharyngeal airway (DPA) device was associated with a reduced need for these maneuvers.

The American Society of Anesthesia Technologists and Technicians (ASATT) Sensor. Fall 2023.

Anesthesia airway management is a crucial component of modern medical practice, enabling the safe and effective administration of anesthesia during surgeries and other medical procedures. In recent years, an aging population with a higher rate of obesity has made patients with a “difficult airway” more common than in the past. While it is possible to address a difficult airway by using external maneuvers, this creates risk for the patient and limits the medical staff. It is far better to have airway devices on hand that are specifically designed to address the problem of distal pharyngeal collapse. A range of such devices is discussed in this paper.

Anesthesia Patient Safety Foundation (APSF) Articles Between Issues, July 16, 2023.

Airway management challenges such as upper airway obstruction and hypoxemia occur frequently in gastrointestinal (GI) endoscopies. Closed claims analyses indicate that GI endoscopy cases are associated with the highest number of malpractice claims for anesthesia providers, highlighting the need for upper airway patency and oxygenation improvements. The Distal Pharyngeal Airway can be placed alongside an EGD endoscope to relieve distal pharyngeal airway obstruction and facilitate effective airway management under sedation.

Anesthesiology News, June 2023, Vol. 20, No. 1, pg 26, Table 7, Ventilation on Oxygenation.

McMurray Enhanced Airway (MEA) - An easy-to-use distal pharyngeal airway (DPA) device that is flexible like a nasal airway but designed for oral use. Opens the obstructed airway beyond the tongue. Soft, flexible tubing with a cushioned bite block that is placed between the molars. With the 15-mm connector, the MEA can attach to an anesthesia circuit or manual resuscitator to allow continuous oxygenation during intubation or intraoral ventilation to ease poor positive pressure mask ventilation.

A & A Practice, June 2023, Vol. 17, No. 6. DOI: 10.1213/XAA.0000000000001691

Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have obstructive sleep apnea—all heightened risk factors for airway complications. These patients undergo procedures where distal pharyngeal tissues can relax, obstructing the airway. As a result, there is a need for airway devices that can stent open distal pharyngeal tissues to maintain adequate ventilation. To physically address this problem, the new distal pharyngeal airway (DPA) prevents airway obstruction and enables providers to maintain ventilation.

Roxanne McMurray, DNP, APRN, CRNA, never set out to be an inventor. Continue reading article in AANA News Bulletin

Anesthesiology News, March 2022 , pg 8-9
Most Airway Management for anesthesia providers and airway experts is routine, predictable  uneventful and straightforward. However, when a challenging airway occurs in a clinical situation it... Read full article 

Highlighted at SAM Scientific Meeting and Workshop in Tucson, AZ. Abstract | Link to Poster

Highlighted at SAMBA Society for Ambulatory Anesthesia in Phoenix, AZ. e-Poster

McMurray R, Gordon L. A Survey of Provider Satisfaction of a New, Flexible Extended-Length Pharyngeal Airway to Relieve Upper Airway Obstruction during Deep Sedation. Enliven: J Anesthesiol Crit Care Med. 2021;8(2):002.
 
MEA use-assessment survey study involved 54 anesthesia providers from 15 U.S. surgery locations. Providers were instructed on MEA use and trialed the airway in adult patients experiencing an upper airway obstruction under deep sedation/MAC. Results include:

• 100% successful in establishing and maintaining a patent airway (n=86)

• 93% of respondents agreed that the MEA was easy to place 

• 98% allowed for a “hands-off approach"

• 86% would improve airway management practice and patient outcomes

This pilot study demonstrated that the novel extended airway is an effective and satisfactory method for anesthesia providers to alleviate airway obstruction during deep sedation 
DOI Link: https://www.medrxiv.org/content/10.1101/2020.11.20.20222018v1.full

McMurray R. A Pilot Study of an Innovative Flexible Extended-Length Airway to Relief Upper Airway Obstruction: The McMurray Enhanced Airway. AANA.com, AANA Foundation 2020 Poster Abstracts. Abstract on page 44. | E-poster presentation

McMurray R, Becker L, Frost Olsen K, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J. 2020, 88(2):123- 129.
 
A clinical observation study (n=243) and an electronic provider survey (n=293) were conducted to examine the practices related to airway management in deep sedation/monitored anesthesia care (MAC). The clinical observation study objective was to investigate reported postoperative sore throat (POST) occurrence associated with use of either a non-traditional airway (nasal airway used orally) or traditional oral airways (TOAs) in deep sedation procedures. Patients receiving non-traditional airways reported significantly (P<.001) less POST.  These results prompted a broader exploration into deep sedation airway practices of anesthesia providers via an electronic survey. The majority of respondents to the electronic survey (n=293) reported adverse effects including gagging/coughing upon insertion, oral cavity injury and bleeding with TOAs. A noteworthy subgroup of the electronic group (52.8%) reported using nasal airways orally to avoid adverse effects associated with TOAs. Investigation outcomes suggest a clinical void in current airway management options for deep sedation. Results indicate providers' interests in airway devices that maintain a patent airway while mitigating adverse effects associated with commonly used traditional airways.

McMurray R. Innovative Airway for Deep Sedation/MAC: A New Solution. The McMurray Enhanced Airway (MEA). Trends in Anesthesia and Critical Care. February 2020. 
 
Anesthesia providers at two different hospitals completed 62 surveys, providing feedback on the McMurray Enhanced Airway (MEA). Of the respondents, 100% reported that the MEA would improve their airway management practice and positively impact patient care. All of the respondents reported that they would recommend the MEA for use in the following ways: for deep sedation/monitored anesthesia care (MAC) airway management, for intraoral ventilation, to help decrease fire risk associated with oxygen delivery, and to prevent collapsing of the laryngeal mask airway (LMA). Of the survey respondents, 95% stated they would use the MEA to prevent collapsing of the endotracheal tube (ETT). 

McMurray R. Innovative Airway for Deep Sedation/MAC: A New Solution. The McMurray Enhanced Airway. 2nd World Airway Management Meeting 2019 poster presentation 325. E-Poster presentation
 
Deep monitored anesthesia care (MAC) administration is increasing and offers patient comfort while preserving spontaneous ventilation. Establishing a patent airway is essential to avoid adverse outcomes from inadequate ventilation and oxygenation—the source in more than a quarter of reported MAC anesthesia closed claims. Pharyngeal airways are often needed. Yet, anesthesia providers often must implement chin lift or jaw thrust to alleviate redundant tissue obstruction. These maneuvers can provoke pain for both patients and providers. Workarounds in airway management have emerged in order to displace redundant pharyngeal soft tissue and improve ventilation and respiratory outcomes. To avoid these workarounds, some of which involve off-label practices of nasal airways used orally, and to provide a needed solution, the McMurray Enhanced Airway (MEA) was developed. To obtain feedback of the MEA, 62 surveys were completed by anesthesia providers at two different hospitals. Of the respondents,100% reported that the MEA would improve their airway management practice and positively impact patient care. Based on the survey data from the first clinical use, the MEA fills a gap in airway management to improve ventilation and respiratory outcomes. The MEA can also aid in intraoral ventilation for challenging-to-ventilate patient populations.