Advances in Supraglottic Airway Dr. K. Sudarshan Consultant Anaesthetist Coimbatore.
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Advances in Advances in Supraglottic Supraglottic Airway Airway Dr. K. Sudarshan Dr. K. Sudarshan Consultant Anaesthetist Consultant Anaesthetist Coimbatore Coimbatore
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Transcript of Advances in Supraglottic Airway Dr. K. Sudarshan Consultant Anaesthetist Coimbatore.
Advances in Advances in SupraglotticSupraglottic AirwayAirway
Dr. K. SudarshanDr. K. SudarshanConsultant AnaesthetistConsultant Anaesthetist
CoimbatoreCoimbatore
Which ones qualify ?Which ones qualify ?
Should satisfy the following Should satisfy the following conditionsconditions
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
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
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
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
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
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
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
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
Single use, cufflessSingle use, cuffless
Integral gastric channelIntegral gastric channel
Epiglottic blocking ridgeEpiglottic blocking ridge
Moulding featureMoulding feature
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
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
Laryngeal tube Insetion.
http://www.youtube.com/watch?http://www.youtube.com/watch?v=cBpU_fJe6ZAv=cBpU_fJe6ZA
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
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
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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