Advances in Advances in SupraglotticSupraglottic AirwayAirway

Dr. K. SudarshanDr. K. SudarshanConsultant AnaesthetistConsultant Anaesthetist

CoimbatoreCoimbatore

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Which ones qualify ?Which ones qualify ?

Should satisfy the following Should satisfy the following conditionsconditions

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1.1. Placed above the vocal cord levelPlaced above the vocal cord level

2.2. Those devices which Those devices which allow hands-free

maintenance of an open airway

3. 3. AAllows spontaneous or assisted

ventilation

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1908- Hewitt Airway1908- Hewitt Airway 1913- Connell 1913- Connell 1915- Lumbard1915- Lumbard 1916 – Mona Roberts1916 – Mona Roberts 1923 - Phillips1923 - Phillips 1924 – Poe1924 – Poe 1930 – Waters insufflation1930 – Waters insufflation 1933 – 1933 – GuedelGuedel 1957- Fink vallecular1957- Fink vallecular 1957 – Safar Airway1957 – Safar Airway 1977 – Berman intubating1977 – Berman intubating 1982 – Patil Syracuse1982 – Patil Syracuse 1983 – Laryngeal Mask – Archie brain1983 – Laryngeal Mask – Archie brain 1985 – Combitube1985 – Combitube

1908 to date1908 to date

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Sir Frederic William Hewitt 1856 - 1916

The originalHewitt airway as it

appeared in theFebruary 15, 1908

issue of The Lancet.

A modified version of the original Hewitt airway

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Dr.Arthur Guedel1883-1956

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Dr.Peter SafarDr.Peter Safar

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Dr. Archie Brain Dr. Archie Brain

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NASOPHARYNGEAL AIRWAY

COPACOPA COMBITUBECOMBITUBE

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AdvancementsAdvancements

New generation LMA’sNew generation LMA’s

I gel I gel

Laryngeal Tube/ King LTS/ LTD Laryngeal Tube/ King LTS/ LTD

Cobra plus tubeCobra plus tube

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Generally demonstrateGenerally demonstrate

Ability to be placed without direct visualizationAbility to be placed without direct visualization

Better cardio vascular stability both during Better cardio vascular stability both during insertion and removalinsertion and removal

Minimal IOP and ICP changesMinimal IOP and ICP changes

Provide little protection against aspirationProvide little protection against aspiration

Contraindicated in full stomach patientsContraindicated in full stomach patients

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Proseal & LMA SupremeProseal & LMA Supreme

Has two separate tubesHas two separate tubes

Three dimensional Three dimensional inflation of cuffinflation of cuff

Holds a better cuff seal Holds a better cuff seal pressurepressure

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Flexible & Ambu LMAFlexible & Ambu LMA

Flexometallic tubeFlexometallic tube

Preformed anglePreformed angle

Better placementBetter placement

Less incidence of Less incidence of dislodgement once placeddislodgement once placed

More useful in head and More useful in head and neck surgeryneck surgery

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ILMA & LMA C TrachILMA & LMA C Trach

Allows intubation with Allows intubation with minimal head and neck minimal head and neck manipulationmanipulation

Recommended in both Recommended in both difficult airway and difficult airway and Resuscitation algorithmResuscitation algorithm

C Trach allows intubation C Trach allows intubation under direct visionunder direct vision

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Single use, cufflessSingle use, cuffless

Integral gastric channelIntegral gastric channel

Epiglottic blocking ridgeEpiglottic blocking ridge

Moulding featureMoulding feature

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Insertion TechniqueInsertion Technique

I GEL INSERTION

http://www.youtube.com/watch?v=8jqHCnThf1E

I GEL insertion in Lateral position

http://www.youtube.com/watch?v=uLtSojaSX6c

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Laryngeal Tube / KING LTS TubeLaryngeal Tube / KING LTS Tube

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King LTD DesignKing LTD Design

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King LTS-D Airway Design

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INSERTION STEPSINSERTION STEPS Use lateral approachUse lateral approach

Introduce the tip into corner of Introduce the tip into corner of mouthmouth

Advance behind the base of Advance behind the base of tonguetongue

Without exercising excessive Without exercising excessive force, advance until the base force, advance until the base of the connector is aligned with of the connector is aligned with teeth.teeth.

Inflate the cuffInflate the cuff

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FINAL POSITIONFINAL POSITION

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Laryngeal tube Insetion.

http://www.youtube.com/watch?http://www.youtube.com/watch?v=cBpU_fJe6ZAv=cBpU_fJe6ZA

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Cobra plus tubeCobra plus tube

Distal end has softened Distal end has softened openingsopenings

Used for both spontaneous Used for both spontaneous and controlled ventilationand controlled ventilation

Serves as a rescue airwayServes as a rescue airway

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Streamlined liner of Pharyngeal airway - Streamlined liner of Pharyngeal airway - SILPASILPA

CufflessCuffless

Lines the pharynxLines the pharynx

Large internal volume –Large internal volume –Allows collection of Allows collection of secretion, minimize secretion, minimize aspirationaspiration

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SummarySummary

Provides hands free maintenance of airwayProvides hands free maintenance of airway

Can be used for both spontaneous and controlled Can be used for both spontaneous and controlled ventilationventilation

Provide little protection against aspirationProvide little protection against aspiration

Useful in Useful in Routine anaesthesiaRoutine anaesthesia emergency airway managementemergency airway management Aid to intubationAid to intubation

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THANK YOUTHANK YOU