DESCRIPION OF SOME OF THE AIRWAY DEVICES USED

1. BASIC
AIRWAY
EQUIPMENTS
Dr VEENA
MOHAN
JR1
ANESTHESIA

2. AIRWAY
PATENT
THREATENED
OBSTRUCTED

3.  FACE MASK
 AIRWAY
 SUPRAGLOTTIC DEVICES
 ENDOTRACHEAL TUBE
 LARYNGOSCOPE
 ADJUNCTS
NASAL AIRWAY
OROPHARYNGEAL AIRWAY
Laryngeal Mask
I GEL
Baska
Mask

4.  Enable gas administration without introducing any apparatus into patients
mouth.
 MADE OF
FACE MASK
Black rubber
Clear plastic

5.  PARTS
BODY(DOME) : if transparent can see the secretions or
exhaled moisture or blood
CONNECTOR: has 22 mm ID
SEAL(RIM) : Part that comes in contact with the face
Cushion type
Infalted with
air
Flap type

6. TYPES
ANATOMIC FACEMASK: Connell/BOC mask
 Black rubber(cant see blood/ secretions/ moisture)
 Good seal
AMBU TRANSPARENT MASK:
 Good seal, thumb rest is present

RENDELL BAKER SOUCEK MASK
 For pediatric cases as it has minimal dead space
 Triangular body
ENDOSCOPIC MASK
 Has port for fibroscope to be inserted

7. TECHNIQUES
1)ONE HAND METHOD:
 Thumb & index finger over body of mask
 Other 3 fingers form E
 Middle & ring finger on mandibular ridge
 Little finger under angle of jaw

8. 2)TWO HAND METHOD/ ESMARCH-HEIBERG MANEUVER,
 Both hands used,
 Both thumb on either side of body of mask
 index fingers are placed under the angles of the jaw.
 The mandible is lifted and the head extended
3) CLAW HAND TECHNIQUE :for pediatric
short ophthalmology procedures

9. COMPLICATIONS
 Skin problems(allergic dermatitis)
 Pressure necrosis
 Nerve injury
 Gastric inflation
 Environmental pollution with anaesthetic gases
 User fatigue
 Jaw pain
 Eye injury
 Eyelid edema
 Corneal abrasion
 Conjuctival chemosis

10.  ADVANTAGE
 Cost effective
 Less chance of sore throat
 Less depth of anaesthesia is needed
 DISADVANTAGE
• Risk of
desaturation
• Difficulty to
maintain an airway
• Fresh gas flow
needed
• Work of breathing
in spontaneously
breathing patient

11. SIZE
AGE SIZE
Infant 0
Small child 1
Child 2
Small adult 3
adult 4
Large adult 5

12.  CLEANING
 Better to use disposable
 If reusing ,rinse, soak & scrub it
 Gas sterilisation
 Pasteurisation
 Liquid chemical agents

13. AIRWAY
Under anaesthesia, muscles of floor of mouth & pharynx relax,it increases the
chance of fall back of tongue and epiglottis ,obstructing the airway
The purpose of an AIRWAY is to lift the tongue & epiglottis away from posterior
pharyngeal wall
 Prevent airway occlusion
 It includes
Nasal airway Oropharyngeal airway

14. NASAL
AIRWAY

15.  Also known as NASAL TRUMPET
 PARTS :bevel end
:flange: to prevent deep passing

16.  SIZE
 Measure the distance from
Lateral edge of nostril to tragus of ear.
if
Too large
Stimulate
laryngeal reflexes
If too small
Obstruction of
airway not relieved

17.  HOW TO USE
Lubricate the entire length,
,airway held with bevel against the septum—
insert perpendicular in line with nasal passage and gently advance posteriorly
Bevel end reach below base of tongue, above epiglottis

18.  USES
 During or after pharyngeal surgery
 To facilitate suctioning
 Guide for nasogastric tube
 To dilate passage for nasotracheal intubation
ADVANTAGE
 Better tolerated
 Can use in oral pathology or loose tooth
 Can be used even when mouth cant be open properly

19. TYPES
LINDER
Has large flange
No bevel at distal end
BINASAL
has 2 nasal airway
connected via adapter
used in babies
CUFFED
Inserted through
nose to pharynx
Cuff inflated

20.  COMPLICATIONS
 Airway obstruction: if its tip press epiglottis or tongue against posterior
pharyngeal wall(PPW)
 Trauma to nose or PPW
 Tissue edema
 CONTRAINDICATION
 Anticoagulation history
 Base of skull #
 Deformity or pathology or sepsis of nose or nasopharynx

21. CLEANING
 Rinse with cold water, then placed in solution of water and detergent
 Pasteurisation,
 chemical disinfection,
 plasma sterilisation

22. OROPHARYNGEA
L
AIRWAY

23. PARTS
FLANGE: seen outside
prevent deeper movement
BITE PORTION: straight ,
Its between teeth & lips
CURVED PART:allow free passage of air
to pharynx

24. SIZE
 Hold it next to patients mouth
 Size measured from midpoint of incisor
to angle of mandible
 If too small: will kink & obstruct
 If too large :traumatise the larynx

25. INSERTION
 Using left hand separate teeth by scissoring
 Insert airway with concave side facing upper lip
 When junction of bite & curved section is near Incisor
rotate it 180 degree and slip it behind the tongue

26.  USES
 Maintain open airway
 Prevent biting & occluding oral tracheal tube
 Protect tongue from biting
 Enable easy oropharngeal suction
 provide pathway to insert device to pharynx

27.  TYPES
GUEDEL
Large flange
Color coded bite block
Smooth bevelled tip
BERMAN
With central support
&
Channel along each
sides allowing a
suction catheter or
ETT to pass through
PATIL SYRACUSE
ENDOSCOPIC AIRWAY
Made of aluminium
Has a central groove &
lateral channels
Enabling fibooptic
intubations

28.  COMPLICATIONS
 Airway obstruction :if tip press epiglottis/tongue against PPW
 Pharyngeal perforation
 Laryngeal spasm
 Edema to tongue, neck,
 Dental damage

29. Group of airway devices that can be inserted into pharynx to allow
ventilation, oxygenation, administration of anaesthetic gases without the
need of endotracheal intubations

30. LMA
 1ST generation
simple airway devices
 Low pressure pharyngeal seal
 It include
 Flexible LMA
 Classic LMA
 2nd generation
 High pressure seal
 Increased protection from aspiration
 Proseal LMA
 I gel

31. LMA CLASSIC
 Supraglottic device
 Parts
2 vertical bars(aperture bar):where the tube enters the mask
:prevent epiglottis obstructing the tube
Shaft/curved tube
Cup/spoon shaped mask with inner rim is inflatable
Airway connector of 15mm diameter
Pilot balloon with valve to inflate the cuff

32. MATERIAL: made of silicone
SIZE:
Too small:leak +
Too large :comes out
LMA SIZE PATIENT WEIGHT
1 INFANTS UPTO 5kg
1.5 5-10 kg
2 10-20 kg
2.5 20-30kg
3 30-50 kg
4 50-70kg
5 70-100kg
6 >100kg

33.  INSERTION
 patient positioned in sniffing position
----hold the LMA in R hand at junction
of shaft and cuff with thumb and index finger
----with aperture facing forward—tube lies
parallel to floor
 Open the mouth as a scissoring,insert the mask
 Mask press against the hard palate with index finger
& further advance using index finger only
-

34.  Once properly placed
 Mask rest on floor of hypopharynx
 Sides faces pyriform fossa
 Upper border of cuff behind base of tongue
 OTHER TECHNIQUES
 If failed,reposition the head and try
 180 TECHNIQUE: insert with laryngeal aperture
points cephalad & rotate it 180 degree as it
Enter hypopharnx
Partly inflation technique

35. ADVANTAGES OF LMA
1. Ease of insertion
2. Smooth awakening
3. Low operating room pollution
4. Can lessen the complications
5. Protection from barotrauma
6. Cost effective
DISADVANTAGES OF LMA
 Cant use in
 Full stomach/pregnancy
 No use in glottis /subglottic obstruction
Aspiration
risk

36.  COMPLICATIONS
1. Gastric content aspirations
2. Gastric distensions
3. Foreign body aspirations
4. Airway obstruction due to malpositioned mask/ epiglottis backfolding
5. Trauma to
 Epiglottis
 Posterior pharyngeal wall
 Uvula
 Soft palate
 Tonsil

37. CLEANING
 Clean with warm water and dilute sodium bicarbonate (dissolve the secretions)
 Rinse with tap water and dried
 Inflation valve should not be exposed to any chemical solution
 Water should not enter the cuff
 Can be autoclaved to 135 degree Celsius or 235 degree Fahrenheit

38. 2.LMA PROSEAL
 STRUCTURE
 Has additional drainage tube
 wire reinforced,shorter ,smaller airway
 accessory vent to prevent secretion pooling
 additional 2nd dorsal cuff
 Shorter lifespan than classic LMA
 USES
For short procedure
In times of difficult face mask procedures
In difficult /failed intubation
In patients with tracheal stenosis
Aid bronchoscopy

39. SIZES

40. 3.LMA UNIQUE
 single use LMA
 Made of PVC
ADV DISADV
Less costly more stiffer
Better in ward use less compliance

41. 4.LMA FLEXIBLE
 Reinforced LMA/RLMA/FLMA
 STRUCTURE: flexible ,wire reinforced tube
tube is longer & narrower
 USE: surgery of head and neck
 ADV:can bent without kinking
 DISADV:
More difficult to insert(use stylet /magill)
Obstruction due to biting
Not suitable for MRI

42. 5)LMA FASTRACH
 Intubating LMA/ILMA/ILM
STRUCTURE:
 short, curved ,stainless steel shaft
 Single epiglottis elevator bar
 Vshaped guiding ramp to direct tracheal tube to glottis
 Curved tip for atraumatic insertion
 Available in 3,4,5 sizes
 ADV:anticipated or unexpected difficult airway
 DISADV:
 May get dislodged easily
 Not suitable for MRI

43. 6)LMA CTRACH
 STRUCTURE:
 2 fiberoptic channels,one to transmit the light
Other to transmit the image
 Monitor attached to see image
 ADV: real time image of larynx is visible
 DISADV:
 poor image quality
 Difficult to use in limited mouth opening cases
CLEANING
can be autoclaved

44. OTHER SUPRAGLOTTIC
DEVICES
1.SOFT SEAL LARYNGEAL MASK:
 Clear, disposable, made of PVC
 No epiglottic bar
 Blue line on convex surface
 2.AMBU LARYNGEAL MASK
 Cuffed, single use, made of PVC
 Built in curve so replicate the anatomy
 No epiglottic bars

45. 3.LARYNGEAL TUBE AIRWAY
 Silicon, reusable,
 2 cuffs..when inflated
 With single inflation line can inflate both cuffs
 ADV: Easy to insert in restricted mouth opening
Proximal cuff :in hypopharynx
Distal cuff:in upper esophagus

46. 4.INTUBATING LARYNGEAL AIRWAY(ILA)
 reusable device( can be autoclaved)
 made of silicone,
 curved tube, dark blue bowl
 keyhole shaped outlet

47. 5)I –GEL
 Soft gellike cuffless SGA, elliptical shaped
 Provide noninflatable anatomical seal
 Has elliptical buccal cavity stabilizer with
 Has a bite block
 Sizes:1, 1.5, 2. 2.5, 3, 4, 5
 ADV:
 minimal tissue compression
 Latex free
Circular airway lumen
Lumen for gastric tube
insertion

48. 6)BASKA MASK
Non inflatable membranous cuff, inflated with PPV produces a seal
has an elbow connector for suctioning
has an opening that sits in upper esophagus
bite block
Seen in 4 sizes

50.  Device to secure patients airway via nose/oral route
MATERIAL
Red rubber PVC
Can reuse less expensive
Get clogged compatable with tissue
Can kink
Not transparent
Rarely can have
silicone
tubes,expensive

51.  Characteristics of material choosen
 Low cost
 Lack of tissue toxicity
 Transparent
 Non inflammable
 Easy to sterilise and durable
 Smooth non wettable surface to prevent pooling of secretion
 Sufficient strength
 Latex free
 Lack of reaction with anaesthetic gases & lubricants

53.  Has
Patient end: with Machine end: receives
connector
a) BEVEL:obliquely cut,it faces the left
forms acute angle with longtitudinal
axis of tracheal tube
b)MURPHY EYE:hole opposite to bevel,
provide alternate flow path for gas
if bevel is occluded
if murphy eye is absent : magill tube

54.  CUFF: Inflatable sleeve near patient end.
Inflated by pilot balloon & inflating tube
ADV of cuffed tube
 perfect sealing of trachea,thus decrease
Chance of aspiration
 Avoid gastric distension duringPPV
 Allows efficient ventilation

55.  2types of tubes based on cuff
 A) HIGH VOLUME LOW PRESSURE
Has large resting volume& diameter
area of contact is larger
ADV:
minimal pressure on tracheal
wall
DISADV
Increased chance of fluid leakage
More difficult to insert
Cuff is likely to torn
Increased incidence of sore throat

56.  B)LOW VOLUME HIGH PRESSURE CUFF
require high intracuff pressure to achieve a seal with the trachea
has small are of contact with the trachea
ADV
Better protection
against aspiration
Less sore throat
DISADV
Ischemic damage to tracheal
wall if left insitu for longer
period

57. TUBE SIZE:
 Standard set by ASTM/ISO
 designated by ID in mm
 Size should be marked b/w cuff & take of point of
inflation tube
Size choosen for male:7.5/8/8.5
for female:7/7.5
for pediatric patients
use uncuffed tube
calculated based on age and weight of the child
<6Yr:(age in yrs/3)+3.75
>6Yr:(age in yr/4)+4.5
 3month:3mm
 3-9months:3.5mm
AGE TUBE SIZE ID in
mm
Prematue <_3
Neonate 2.5-3.5
1-6mon 4-4.5
6-12mon 4.5-5
1-4yr 4.5-5.5
4-6yr 5.5-6.5
7-10yr 6.5-7
10-14yr 7-7.5

58.  TUBE LENGTH
 As ID length also
TUBE MARKINGS
1.Word’ORAL’/ NASAL
2.Size in ID in mm
3.OD if size <6
4.Name of manufacturer
5.graduated markings showing distance
from patient end in cm
6.single/reuse
7.Radioopaque at patient end or in entire length

59.  INSERTION
 POSITION :patient is in SNIFFING THE MORNING AIR /CHEVALIER JACKSON
POSITION
 Flexion at cervical spine
 Extension at atlanto occipital joint
 So that oral, pharyngeal &laryngeal axis is
alligned, thus it optimise the vocal cord
visualisation

60. INSERTION
After laryngoscopy,
proper size tube is passed from right corner of the mouth
Through the vocal cord, until the transverse black line in the tube has passed the
Vocal cords
Confirm the intratracheal placement of the tube
Signs
 Visualise tube passing through the cord
 Capnography
 Feel and compliance of the reservoir bag
 Chest wall rise
 Auscultation of the chest wall
 Movement of mist in tube
Then cuff is inflated :pressure of 18-25mm Hg(25-34 cm H2O)

61.  Intubation
 trauma for lip, tonsil,
tongue, nose, pharynx,
trachea
 Vocal Cord avulsion,
arytenoid dislocation
 BP HR ICT
IOP
 Bronchosperm
 Airway perforation
 Esophageal intubation
 Failed intubation
Complication of ETT
 ETT in place
 Disconnect
 Airway
obstruction
 At extubation
 Laryngeal
edema
 aspiration
 After
extubation
 Sorethroat
 Laryngeal
edema
 Nerve injury
 Ulcer
 Vocal cord
palsy
 Tracheal
stenosis

62.  Indication of tracheal intubation
 To secure and maintain airway
 To protect against aspiration of
gastric content
 Provide positive pressure
ventilation
 During respiratory obstruction
 Contraindication of tracheal
intubation( increased risk in)
 Severe airway trauma
 Laryngeal edema
 Arch of aorta aneurysm
 Cervical spine injury

64. 3)COLES
TUBE
 In neonates,
 uncuffed
 has tapering point end, then has shoulder like part which is broader
 Disadvantage
 - it can traumatise the larynx
 Can’t insert through nose.

65. 4)RAE TUBE (RING ADAIR ELWYN) /
PREFORMED TUBE
 Has preformed bend
 For head and face surgery
 Advantages –less chance of accidental extubation, can give wider surgical field
 Disadvantages- difficult suction
 Two types
South Polar
• Bend at acute angle
• Rest on Patient’s chin
• Connector on chest
• Use: cleft lip, palate, nasal surgery
North Polar
• Cephalic curve
• Connector on forehead
• Use: lower face, mandible, floor of
mouth surgery

66. 5FLEXOMETALLIC OR ARMOURED TUBE
 Metal or Nylon spiral within the wall
 ADVANTAGE
 Flexible
 Non-kinking
 Can pass over fibro optic bronchoscope
 DISADVANTAGE
 No Murphy eye
 Difficult to insert
 Not reusable
 USE
 In tracheostomy
 Submental intubation

67. 6)MICROLARYNGEAL TUBE
 High volume, low pressure cuff
 Size- 4,5,6 (ID in mm)
 USE- For Microlaryngeal Surgery
 ADVANTAGE
 Small bore
 Used in narrow airway
 Better visibility
 Can use in intubation via LMA
 DISADVANTAGE
 Not laser resistant
 Occlusion chance is high

68. LARYNGOSCOPE

69. It’s a device to visualise the interior of larynx
including VC to aid endotracheal intubation
HANDLE
Has battery
for light
source
FITTING
Connection point
between handle & blade
Hook on
fitting type
Pin fits
through
holes
BLADE

70.  BLADE OF LARYNGOSCOPE
 BASE:part attaching to handle
 HEEL:proximal end of base
 SPATULA:compress tongue
&soft tissue
 FLANGE:Parallel to tongue,
deviates the tongue
 TIP:elevate the glottis
has the light source

71.  MACINTOSH BLADE
 Mc used
 Spatula has greater curve
 Cross section of spatula &flange
makes reverse Z
 Blunt tip
 Interchangable blade
MILLER BLADE
• Straight
• Used commonly in
pediatric patients
• Used in patients with
• Floppy epiglottis
• Micrognathia
• Prominent incisor
• Short neck

72. SIZE OF TUBE
SIZE USED IN
0 NEONATE
1 SMALL CHILD
2 CHILD
3 ADULT
4 LARGE ADULT
5 EXTRA LARGE ADULT

73.  INSERTION
 Position the patient head in sniffing position
 Hold laryngoscope in left hand
 Introduce through R side of mouth
 Advance behind the base of the tongue,
elavate it until epiglottis is seen
 Lift epiglottis to see vocal cord
 Insert the tube
If difficulty to see cord
o Use stylet
o BURP manuever: backward upward rightward pressure on thyroid cartilage
o Use flexi tip laryngoscope
o Blindly introduce

74.  COMPLICATIONS
 Injury to lip,tonge,hard & soft palate,epiglottis,
 Damage to teeth, gums
 Injury to cervical cord
 Foreign body swallow / aspiration
 Burns
 Laryngospasm
 Vagal stimulation

75. 1) McCoy
: macintosh blade with adjustable tip
Adjusted by lever in handle
Uses:in difficult intubation

76.  2)BULLARD LARYNGOSCOPE
 Its indirect rigid fibrooptic laryngoscope
 Used in
 Restricted mouth opening
 Limited neck movements
Here endotracheal tube is preloaded in the wire & introduce along with it

77.  3)POLIO BLADE
 For obese cases
 Has obtuse angle
4)OXIPORT BLADE
 Has port for oxygen delivery

78.  5)BIZZARRI GIUFFRIDA BLADE
 Macintosch with flange is removed
 Adv:damage to upper teeth is reduced
 Used in:
 Limited mouth opening,
 Prominent incisor
 Receding mandible
 Short & thick neck
 Anterior larynx

79. 6)VIDEO LARYNGOSCOPE
 ADV:
 able to visualise the anatomy
 Monitor the intubating process
 Less neck movement required
DISADV:cant use in outside health care facility

80. 7)FLEXIBLE FIBEROPTIC ENDOSCOPE
 Also known as fiberscope
 PARTS
LIGHT
SOURCE
HANDLE
Houses the battery
Its held in hand
Has eyepeice, focussing
ring,working channel port,tip
control lever
INSERTION CORD
Part inserted into patient
It has image conducting bundle,
Light conducting bundle
Working channel for
suction/medication
administartion

81.  INSERTION
 Can be inserted orally/nasally
 Preferred in awake intubation
 Used to
 Place and evaluate placement of tracheal tubes
 Check tube patency
 Evaluate the airway
 Locate & remove secretions
ADV:
 Reliable for difficult airway management
 Intubate those with unstable cervical spine
 High risk dental damage

82.  DISADV:
 More expensive
 Difficult to maintain
 Require more time and skill
 Cant directly manipulate airway structures
 COMPLICATIONS
 Gastric distension,
 Tension pneumothorax
 Subcutaneous emphysema

83. AIRWAY MANAGEMENT
ADJUNCTS
 1)STYLETS
 It fit in a tracheal tube,change the shape of the tube facilitating the insertion
 Disadv:
 trauma to airway & oesophagus
 Can damage the tube

84.  2)BOUGIES
 Eschmann tracheal introducer
 Distal end is angled 30 degree,makes it easier to pass
 Once bougie is in trachea, advance the tracheal tube over the bougie
 Once ETT Is in, withdraw the bougie
 DISADV
 Trauma can occur to airway
 Source of contamination

85.  3)MAGILL FORCEPS
 USES
 Direct tracheal tube to larynx
 Direct gastric tube to esophagus
 COMPLICATIONS
 Cuff of tube may be damaged
 Damage to airway mucosa