IP Requirement: Emory IP

Experience Requirement:

– Mechanical Design

– Rapid Prototyping

Monitored anesthesia care (MAC), also known as deep sedation, comprises a large portion of anesthesia care provided in the US. In 2006, 47% of all ambulatory surgeries are performed under MAC. MAC is usually preferred when appropriate as it avoids (planned) invasive airways, speeds discharge and reduces costs. To ensure patient’s unconsciousness and immobility during the procedure, anesthesia providers tend to err on the side of running sedation deeper, in which case airway collapse commonly occurs, causing hypoventilation, desaturation and requiring immediate intervention. This is particularly common in patients with obesity and existing obstructive sleep apnea.

An easy and effective solution in this scenario is applying manual chin lift or jaw thrust for the patient. These maneuvers displace the tongue and relieve upper airway obstruction. Then the provider has to choose to either reduce sedation, which risks patient movement and awareness, or find a way to maintain a patent upper airway. The latter can be achieved by inserting airway devices, e.g. oral airway or nasal airway. However when done at an unideal depth of anesthesia, these devices can cause significant airway irritation or injury, leading to secretions, cough, bleeding or even laryngospasm. Another common approach is to position patient’s head of bed slightly to either side hoping it relieves obstruction, however this is frequently unsuccessful. There had been more recent inventions like JED Jaw Elevation Device by HYPNOZ therapeutic devices, that had not received widespread popularity. A few potential caveats of this device include its cost (~$500), size (to already limited space in operating room), need for cleaning after single use and the fact that jaw thrust, compared to chin lift, is much more stimulating and rarely needed for patients under MAC. In many cases, provider then have no choice but to intermittently, if not continuously, perform a chin lift or jaw thrust. This significantly diverts provider attention from other aspects of care, e.g. administering important medications (e.g. antibiotics) and maintaining normal hemodynamics. This is particularly challenging when provider does not have ready access to head of the patient, e.g. in anesthesia care for interventional radiology or magnetic resonance imaging, sometimes causing significant hypoventilation before noticing. 

We propose a chin lift device to allow for reduction of airway obstruction during deep MAC. This device should be able to sustain a chin lift for patients without manual effort. It would ideally be small, lightweight and portable. It needs to be soft and safe, compatible with oxygen masks and most operating room beds on the market. This would allow providers to be free from burden of constant airway intervention, and focus on other important aspects of anesthesia care, reducing cognitive load and improve safety margin of care. If successful, this device would assist large numbers of anesthesiologists, anesthetists, and sedation nurses in a number of procedures throughout the nation.