Use of cuffed oropharyngeal airway (COPA) for awake intracranial surgery

A comprehensive anesthetic plan for managing patients undergoing "awake" intracranial surgery (AICS) must include a means of rescuing the patient if the airway becomes obstructed. Since access to the patient's airway is limited, mask ventilation can be challenging and laryngoscopy and tracheal intubation, impossible. The need exists for an alternative airway device that is easy to insert, would allow controlled ventilation, and would facilitate a smooth emergence with minimal coughing. The cuffed oropharyngeal airway (COPA) was introduced as a supraglottic airway device in spontaneously breathing patients. The authors report their preliminary experience of its use in AICS. The COPA was inserted in 20 patients on 31 occasions. Insertion of the COPA was accomplished easily at the first attempt in all cases irrespective of patient position. Airway maneuvers were required when patients were supine but not lateral. The COPA is a useful device to instrument the airway in patients undergoing AICS using the asleep-awake-asleep technique in the lateral position.