1. Alternative airway devices
Dr Sadia Farhan

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

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

4. 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

5. 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

6. 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.

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

8. 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.

9. 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.

10. 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

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

12. 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

13. 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

14. 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.

15. 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

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

17. 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 .

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

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

20. 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

21. 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

22. 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

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

24. 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

25. 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

26. 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.