This document discusses various artificial airways used to maintain the airway, including oropharyngeal airways, nasopharyngeal airways, endotracheal tubes, and tracheostomy tubes. Oropharyngeal airways are used to maintain the airway in unconscious patients and protect endotracheal tubes from being bitten. Nasopharyngeal airways can be used if oral airway placement is difficult. Endotracheal tubes come in various sizes and types for different procedures and patient populations. Tracheostomy tubes include J-shaped tubes which reduce the risk of accidental disconnection.

1. INFRAGLOTTIC AIRWAYS
ARTIFICIAL AIRWAYS
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical Care/ER

2. Infraglottic Airways
Purpose
Lift the tongue &
epiglottis away from the
posterior pharyngeal wall &
prevent them from
obstructing the space
above larynx

3. OBJECTIVES
-Oropharyngeal
-Nasopharyngeal
-Endotracheal Tubes
-Tracheostomy tubes

4. Oropharyngeal airway
Indications
–
–
-- Maintain airway in the unconscious
patient
-- Protects an Endotracheal Tube from
being bitten
-- Facilitates Airway Suctioning

5. Guedal Airway

6. Berman Airway
--It has a center support &
open sides
--Has a flange at the buccal
end

7. Ovassapian Airway
--The Ovassapian airway is used
to facilitate fiber-optic intubation.
--Overall shape is similar to a
Geudal airway, but is open on the
top
--A tubular shaped
guide in the center
facilitates passage of
fiber-optic
laryngoscope.

8. Williams Intubating Airway
--This is designed to
facilitate fiber-optic
intubation.
--It is similar in profile to the
guedal airway, it is open on
the distal half, and cylindical
at the proximal portion.
--It is only available in 2
sizes 9 cm and 10 cm.

9. --A Guedal airway with
an inflatable cuff to
seal the oropharynx
--A 15 mm connector to
attach to breathing circuit
--Cuff inflated with 25 to 40
cc air
--Cuffed Oropharyngeal
Airway (COPA)

10. LT Oro pharyngeal Airway
--This has a 15 mm adaptor for
connection to the anesthesia
circuit.
--Come in different sizes and are
color coded.
--They are not available
in pediatric sizes.

11. Nasopharyngeal Airway
Indications
–
•
–
Airway maintenance If Oral Airway
placement is difficult
Nasotracheal intubation is the
answer
Complications
–
–
–
–
-Esophageal intubation (if too long)
-Laryngospasm
-Vomiting
-Nasal mucosa injury and
-Secondary blood aspiration

12. ENDOTRACHEAL
TUBES

13. Determining Sizes
Internal Diameter (ID)
•
Newborns
-<28 wks (<1000 g): 2.5 mm
-28-34 wks (1000-2000 grams): 3.0 mm
-34-38 wks (2000-3000 grams): 3.5 mm
->38 wks (>3000 grams): 3.5 to 4.0 mm

14. Intermediate Tracheal Tube
--Excellent for oral and nasal
intubations where a shorter cuff
is desired
--Features:
– Murphy tip and eye
– Tip-To-Tip radiopaque
line
– Pilot balloon and
mechanical self-sealing
valve

15. Tracheal Tube
--Meets the guidelines of
the cuff criteria.
--Thin cuff conforms to
uneven tracheal surfaces
to create low pressure
seal.
--Large cuff diameter of 1- 1/2
times the average trachea
maintains proper low-
pressure seal

16. COLE TRACHEAL TUBE
--Patient end smaller
than rest of tube
--Sized according to
the ID of the tracheal
portion
--Widened portion should
not contact larynx
--Cannot be used nasally as
the wide segment will not
pass through nares

17. Evac Endotracheal Tube with
Evacuation Lumen
-- Convenient and safe
method for suctioning
accumulated secretions
in the subglottic space
-- Low VAP incidence
-- Useful for
a-gas sampling
b- airway pressure
monitoring
c- giving drugs and
d- jet ventilation

18. Jet Tracheal Tube
--Features:
– Magill curve
– Uncuffed
--Includes:
– Main Lumen for
ventilation
– Insufflation lumen
permits the delivery of
jet ventilation

19. Endobronchial double lumen tube

20. With CPAP System
-- Improves oxygenation
during one-lung anesthesia.
-- Anesthesia bag to aid
opening alveoli
-- Adjustable valve supplies
pressures in clinical settings
from 1 to 10cm H20

21. Oral Ring Adair Elwin tracheal Tube
--Preformed curve removes
circuit from surgical field.
--Unique design assures patent
airway while reducing risk of kinks
and disconnects.
--Rectangular mark at
preformed curve aids
correct positioning.

22. Nasal RAE Tracheal Tube

23. Indications
--Nasal surgery & Facial surgery
--Ophthalmic surgery
--Prone positioning

24. Laser – Flex Tracheal Tube
--Stainless steel body is
airtight, flexible and laser-
resistant.
--Reflected beams from the
tube are defocused to
reduce accidental laser
strikes to healthy tissue.
--Smooth surface and Magill
curve minimize trauma
during intubation.

25. Combitube

26. Features
--For difficult or emergency intubation.
--Blind placement without laryngoscope.
--Unique design provides patent airway with
either esophogeal or tracheal placement.
--Reduces risk of aspiration of
gastric contents.

27. Lo-Contour Tracheal Tube
--Cuff lies close to the tube
while deflated for better
view of vocal cords
--Translucent white tube is
easy to see in trachea
--Adequate cuff diameter
provides low-pressure
seal.

28. ET Tube with Controllable Tip
--Loop controls the
direction of the tip
--Radius of curvature is
reduced by pulling the
loop
--Useful in blind intubations

29. Reinforced Tracheal Tube
--Soft, flexible PVC tube with
spiral-wound reinforcing wire
--Reduced risk of kinking.
--Reinforcing wire is sealed
tightly against bonded
connector.

30. Tube with Lanz Pressure Regulating
Valve
-Reduces risk of
tracheal damage during
long-term intubations.
-Lanz valve reduces the
need for manual cuff
pressure monitoring.

31. Microlaryngeal Tracheal Tube
--Small cuff size & I.D. and O.D.
provide greater access
--ID of 4, 5 or 6 mm only
--Cuff diameter: that of 8 mm
tube
--Used when airway has been
narrowed by a tumor or other
abnormality.

32. Preformed Laryngectomy Tube

33. Uncuffed Tracheal Tube
--Wide range of pediatric
sizes
--Provides better fit even for
premature infants.
--Distal tip reference lines
and depth marks
--Thin, but strong tube wall
provides maximum inner
diameter for proper
ventilation.

34. Uncuffed Tracheal Tube with
Monitoring Lumen

35. Tracheostomy
Tubes

36. J Shaped Tracheostomy Tubes
--Available in larger sizes
for patients with a
tracheostomy
--The short portion of the J
is inserted into the
trachea, and the long
portion lies flat against the
chest
--Reduces risk of
accidental
disconnection/extubati
on

37. Summary
--Oropharyngeal airways
--Nasopharyngeal airways
--Endotracheal Tubes
--Tracheostomy tubes

38. THANK YOU