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1. Advances in
Supraglottic Airway
Dr. K. Sudarshan
Consultant Anaesthetist
Coimbatore

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Which ones qualify ?
Should satisfy the following
conditions

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1. Placed above the vocal cord level
2. Those devices which allow hands-free
maintenance of an open airway
3. Allows spontaneous or assisted
ventilation

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 1908- Hewitt Airway
 1913- Connell
 1915- Lumbard
 1916 – Mona Roberts
 1923 - Phillips
 1924 – Poe
 1930 – Waters insufflation
 1933 – Guedel
 1957- Fink vallecular
 1957 – Safar Airway
 1977 – Berman intubating
 1982 – Patil Syracuse
 1983 – Laryngeal Mask – Archie brain
 1985 – Combitube
1908 to date

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Sir Frederic William Hewitt
1856 - 1916
The original
Hewitt airway as it
appeared in the
February 15, 1908
issue of The Lancet.
A modified version of
the original Hewitt
airway

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Dr.Arthur Guedel
1883-1956

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Dr.Peter Safar

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Dr. Archie Brain

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NASOPHARYNGEAL
AIRWAY
COPA COMBITUBE

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Advancements
 New generation LMA’s
 I gel
 Laryngeal Tube/ King LTS/ LTD
 Cobra plus tube

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Generally demonstrate
 Ability to be placed without direct visualization
 Better cardio vascular stability both during
insertion and removal
 Minimal IOP and ICP changes
 Provide little protection against aspiration
 Contraindicated in full stomach patients

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Proseal & LMA Supreme
 Has two separate tubes
 Three dimensional
inflation of cuff
 Holds a better cuff seal
pressure

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Flexible & Ambu LMA
 Flexometallic tube
 Preformed angle
 Better placement
 Less incidence of
dislodgement once placed
 More useful in head and
neck surgery

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ILMA & LMA C Trach
 Allows intubation with
minimal head and neck
manipulation
 Recommended in both
difficult airway and
Resuscitation algorithm
 C Trach allows intubation
under direct vision

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 Single use, cuffless
 Integral gastric channel
 Epiglottic blocking ridge
 Moulding feature

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Insertion 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 Tube

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King LTD Design

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King LTS-D Airway Design

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INSERTION STEPS
 Use lateral approach
 Introduce the tip into corner of
mouth
 Advance behind the base of
tongue
 Without exercising excessive
force, advance until the base
of the connector is aligned with
teeth.
 Inflate the cuff

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FINAL POSITION

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Laryngeal tube Insetion.
 http://www.youtube.com/watch?v=cBpU_fJ
e6ZA

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Cobra plus tube
 Distal end has softened
openings
 Used for both spontaneous
and controlled ventilation
 Serves as a rescue airway

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Streamlined liner of Pharyngeal airway -
SILPA
 Cuffless
 Lines the pharynx
 Large internal volume –
Allows collection of
secretion, minimize
aspiration

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Summary
 Provides hands free maintenance of airway
 Can be used for both spontaneous and controlled
ventilation
 Provide little protection against aspiration
 Useful in
 Routine anaesthesia
 emergency airway management
 Aid to intubation

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THANK YOU