A/Z Airway
A supraglottic airway, that as a single device gives the ability to switch between supraglottic and endotracheal ventilations in a bidirectional manner.
About
Drs. Rafi Avitsian and Andrew Zura recognized a need for the ability to switch between a supraglottic airway and endotracheal ventilation in clinical practice. Despite being limited by the size of the endotracheal tube, utilizing traditional devices, intubation through a supraglottic airway is possible. The reverse, i.e. converting an existing endotracheal tube to a supraglottic ventilation without stopping ventilation, in a single device is not possible. The innovative A/Z Airway and its unique ACCESS SLOT allows the clinician to easily switch between the two types of ventilation.
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The Need
The A/Z airway facilitates supraglottic and endotracheal ventilation using a single device that can convert them without stopping the ventilation. Some of the clinical use scenarios that can benefit from this device include:
• Airway rescue device allowing easy intubation after establishing SG ventilation
• Smooth intra-procedural conversion from SGA to ETT and reverse
• True staged extubation before removal of ETT
• Tracheal rest in prolonged intubation
• Safety device for tracheostomy procedures
• Safety device facilitating retrograde intubations
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About Dr. Rafi Avitsian
Rafi Avitsian M.D. FASA, is a Professor of Anesthesiology in the Department of Anesthesiology in Cleveland Clinic. He is the immediate past president of the Cleveland Clinic Medical Staff Office, as well as the past program director of Neuroanestheisology Fellowship. He is one of the founders of International Council for Perioperative Neuroscience Training (ICPNT) which is the accreditation body of Neuroanesthesiology Fellowships worldwide. He is the past president of Society for Neuroscience in Anesthesiology and Critical Care (SNACC), American Board of Anesthesiologists Applied Senior Examiner, a member of the Association of University Anesthesiologists & recipient of ASA-SEA Distinguished Education Award. He was awarded (SNACC) Teacher of the Year, Lifetime Educator award in 2023. He is a founding board member of International Center for Professional Development (ICPD) in Armenia.
His academic interest is centered in brain tumors, anesthetic methods for seizure surgery, brain protection and outcomes of spine surgery as well as Difficult Airway Management. His clinical studies are mostly directed to finding ways to improve the outcome after neurosurgical procedures. He is also interested in medical innovations with many filed and published patents for medical devices.
More than 50 published peer reviewed manuscripts, two book chapters and many abstract presentations also highlights his academic achievements. He is on the editorial board of Journal of Neurosurgical Anesthesiology and an ad hoc reviewer for Anesthesiology, Anesthesia Analgesia, and World Neurosurgery Journals.
His academic interest is mostly in brain tumors, anesthetic methods for seizure surgery, brain protection and outcomes of spine surgery as well as Difficult Airway Management. His clinical studies are mostly directed to finding ways to improve the outcome after neurosurgical procedures. He is also interested in medical innovations with many filed and published patents for medical devices.
More than 50 published peer reviewed manuscripts, two book chapters and many abstract presentations also highlights his academic achievements. He is on the editorial board of Journal of Neurosurgical Anesthesiology and an ad hoc reviewer for Anesthesiology, Anesthesia Analgesia, World Neurosurgery Journal.
Airway Rescue
When encountering a difficult airway, the A/Z Airway will allow easy conversion from supraglottic ventilation to intubation while safely maintaining ventilation in the patient. If a decision is made to perform a retrograde intubation, the A/Z Airway will allow ventilation, easy guidewire capture as well as serve as a conduit for the intubation process.
Prolonged Intubation /Staged Extubation
Prolonged intubation poses a number of risks to patients, most notably damage to the vocal cords as well as the tracheal mucosa. The ability to retract a patients endotracheal tube into the A/Z Airway for intervals of time could contributed to reduce the incidence of these complications occurring. The process of extubation in critically ill patients frequently takes a long time as often it is difficult to predict if a patient will tolerate being extubated. The A/Z Airway provides an intermediate step to allow the clinicians to evaluate the patient’s respiratory status as well as laryngeal function prior to being fully extubated and facilitating easy rapid reintubation if required.
Smooth Emergence
A supraglottic airway is better tolerated by patients and they require less sedation. By switching an in situ ETT to a supraglottic airway, sedation can be decreased and extubation made smoother. This method can also be used to provide a neurological exam with less chance of coughing.
Improved Tracheostomy Safety
During tracheostomy, it is not uncommon for the endotracheal tube cuff to become ruptured. The use of the A/Z Airway allows the endotracheal tube to be retracted safely into the body of the A/Z Airway while continuing to ventilate the patient in a supraglottic manner.