Alternative airway devices Dr Sadia Farhan

Multilumen Airways Inserted blindly Proven to secure airway and allow for better ventilation. Two devices: Pharyngotracheal lumen airway Combitube

Multilumen Airways Combitube Long tube Can be used for ventilation whether it is inserted into the esophagus or trachea

Multilumen Airways Indications Contraindications Unresponsive, apneic patients with no gag reflex in whom intubation is not possible Cannot be used in children younger than 16 years Only use for patients between 5 ft and 7 ft tall. Contraindications Esophageal trauma Known pathologic condition of the esophagus Ingestion of a caustic substance

Multilumen Airways Disadvantages Advantages Wrong port results in no pulmonary ventilation Risk of aspiration Intubating the trachea via direct laryngoscopy is challenging. Advantages Ventilation in esophagus or trachea Insertion is easier than ET intubation Minimal cervical spine movement No mask seal Airway patency

Complications of Multilumen Airways Unrecognized displacement into esophagus Laryngospasm, vomiting, hypoventilation Pharyngeal or esophageal trauma Ventilation may be difficult if the pharyngeal balloon pushes the epiglottis over the glottic opening.

Insertion Techniques Combitube consists of: Single tube with two lumens Two balloons Two ventilation attachments Before insertion, prepare equipment.

Insertion Techniques Head should be in a neutral position Insert thumb into the mouth and lift the jaw. Insert device until incisors are between the two black lines Two valves must be inflated sequentially.

Insertion Techniques After inflation of balloons, begin to ventilate Through the longer (blue) tube first Observe for chest rise and auscultate. If there are no breath sounds, switch to the shorter (clear) tube. Continuously monitor ventilation.

Laryngeal Mask Airway (LMA) Option for patients who: Require more support than bag-mask Do not require ET intubation Conduit from glottic opening to ventilation device

Laryngeal Mask Airway (LMA) Surrounds larynx opening with an inflatable cuff Cuff conforms to airway contours, forms airtight seal

Laryngeal Mask Airway (LMA) Indications and contraindications Alternative to bag-mask ventilation Less effective in obese patients Pregnant patients and patients with a hiatal hernia are at risk for regurgitation. Ineffective with patients requiring high pulmonary pressures

Laryngeal Mask Airway (LMA) Advantages Better ventilation No continual maintenance of a mask seal No laryngoscopy Less risk of trauma Protection from secretions Disadvantages No protection against aspiration Air may be insufflated into the stomach

Complications of Using LMA Involve regurgitation and aspiration Weigh against risk of hypoventilation Hypoventilation of patients who require high ventilatory pressures can occur. Upper airway swelling has been reported.

Equipment for LMA Seven sizes; based on the patient weight Consists of tube and inflatable mask cuff Two bars at opening prevent occlusion Proximal end is fitted with standard adapter

Equipment for LMA Cuff has a one-way valve assembly 6.0-mm ET tube can be passed through size 3 or 4 LMA

King LT Airway Latex-free, single- use, single-lumen Positive-pressure ventilation for apneic patients Maintains airway in spontaneously breathing patients who need advanced management .

King LT Airway Curved tube with ventilation ports between two inflatable cuffs Can be inserted more easily than the Combitube

King LT Airway Two types: King LT-D: used for adults and children King LTS-D: used for adults Five sizes of each type

King LT Airway King LT-D and LTS-D share many features: Proximal pharyngeal cuff, distal cuff, ventilation outlets ET tube introducer can be inserted through the tube Distal end: closed in LT-D; open in LTS-D

King LT Airway Indications Contraindications Alternative to bag-mask ventilation Same considerations as Combitube Contraindications Patients with an intact gag reflex Patients with known esophageal disease Patients who have ingested a caustic substance

Complications of the King LT Airway Laryngospasm, vomiting, hypoventilation Trauma from improper insertion technique Pharyngeal balloon may push the epiglottis over the glottic opening May make ventilation difficult

Insertion Technique Patient’s height and weight determine size you should use.

Cobra Perilaryngeal Airway (CobraPLA) Shape lets device: Slide easily along the hard palate Hold airway’s soft tissue away from the laryngeal inlet Available in eight sizes

Cobra Perilaryngeal Airway (CobraPLA) Indications Usage similar to other supraglottic airway devices Can be used in pediatric patients Does not protect against aspiration Contraindications Risk for aspiration Risk for massive trauma to oral cavity

Contraindications and Complications Laryngospasm may occur with intact gag reflex Cuff inflation may cause tongue to disrupt seal. Patient cannot be ventilated if device is too small.