ARTIFICIAL AIRWAYS ( OPA,NPA, ET, SGA, LMA, COMBI, KINGS LT, TRACHEOSTOMY)

1. ARTIFICIAL AIRWAY
VINCENT MANI. V
B.SC. AECT

3. ABSTRACT :
• Introduction
• Definition
• Purpose
• Basic airway measures
And examination
• Artificial airways :
• Oropharyngeal airway
• Nasopharyngeal airway
• Endotracheal tube
• supra glottic airways
• LMA and it’s type
• combitube
• Kings Lt
• Tracheostomy

6. INTRODUCTION :
In “ 5 phase of emergency management ‘,
AIRWAY is a first and foremost thing to
manage in scene
Airway defined as the passage of into
The lung ( from nasal cavity
to lung )

7. ANATOMY OF AIRWAY

8. Air
|
Nasal cavity
|
Pharynx
|
Larynx
|
Trachea
|
Bronchus, bronchioles
|
Lung
Upper respiratory
tract
Lower respiratory tract

9. ARTIFICIAL AIRWAY – DEFINITION :
Artificial airways which these are the device
insert into the respiratory tract,
To manage obstruction..
To ventilate the lung..
To Prevent obstruction….

13. AIRWAY MEASURES :
• Jaw thrust
Head tilt chin lift Jaw thrust

14. Modified jaw thrust Cricoid pressure

15. COMMON AIRWAY EXAMINATION :

17. CORMACK & LEHANE GRADE :

19. ARTIFICIAL AIRWAYS

20. AIRWAYS:
• Oropharyngeal airway
• Nasopharyngeal airway
• Endotracheal tube
• supra glottic airways
• LMA and it’s type
• combitube
• Kings Lt
• Tracheostomy
•

22. CHOICE FOR ARTIFICIAL AIRWAY :
It’s based on patient consciousness status and signs
and symptoms of the patient….
• If pt conscious , Mx for obstruction means –
nasopharyngeal airway
• If pt impaired conscious means – oropharyngeal
airway
• Unconscious pt means – Et, lma, combitube

23. OROPHARYNGEAL AIRWAY:

24. OPA:
• OPA otherwise known Gudeal airway.
• It’s a hard and rigid , curved plastic device that is designed
to go over the back of the tongue.
• Aids airway suctioning, prevent tongue fall.
• Ranging from 00 to 6
• Various types used in different different situations.

25. INDICATION AND CONTRAINDICATION :
• Indication : unconscious patient without gag reflex and
helps to prevent the tongue flling into the airway
• Contraindication : conscious patient,
• Patient with gag reflex.

26. SIZE AND COLOUR :

27. MEASUREMENT :

28. INSERTION TECHNIQUE :

29. NOTE :

30. COMPLICATION :
• Vomiting and aspiration
• Dental damage
• Oral damage
• Larynhospasm
• Laryngospasm
• Obstruction in airway – In appropriate size

31. NASOPHARYNGEAL
AIRWAY

32. NPA :
• These are soft plastic or rubber tube that’s placed
into the nasal cavity for the purpose of ventilation
• It’s placed on inferior to the base of the tongue.
• It’s mainly used in ithe patient with gag reflex
• Size varying from 17 to 26 mm length or 6 to 9
internal diameter.

33. INDICATION AND CONTRAINDICATION :
• Indication : conscious patient with gag reflex….
• Contraindication : sinusitis, otitis,bnasal necrosis,
• Base of the skull fracture, patients who are taking
anticoagulant

34. S
I
Z
E
:

35. MEASUREMENT :

36. INSERTION TECHNIQUE :
• Before inserting the tube check the nostrils ( lesion,
sign of fracture, sinusitis )
• Position the patient : sniffing position
• Measure the size with the help of measurement
technique
• And then lubricant the tube
• Gentely insert the tube …. Don’t force it…Insert till
flange….

37. COMPLICATION :
• Epistaxis
• Laryngospasm
• Coughing
• Sinus infection
• Significant facial, basilar skull fracture

38. ENDO TRACHEAL
TUBE

39. ET :
• It’s a rigid tube placed into the trachea for the
purpose of establising and maintaining patent
airway and ensure exchange of o2 and co2
• Its available in 2 to 10.5 mm ID.
• Its available in silicone rubber, latex rubber, Stainless
steel

40. P
A
R
T
S

41. TYPES :
1. Cuffed
2. Uncuffed
• From 2.5 to 6.0 mm Internal diameter ET tube does not
Contains cuff …these are the types used in pediatric case (< 8
yrs)
• Uncffed in pediatric - Because they have a narrow subglottic
area….This anatomical position helps to prevent the tube fall
or displacement
• Cuffed ET – used in >8 yrs

42. INDICATION :
RHANA C
• R – Respiratory failure
• H – Head injury / Hypoxia
• A – Acidosis
• N – Neurological defect ( like myasthenia gravis)
• A – Anaphylaxis / anesthetized patient ( GA)
• C - Coma

43. CONTRAINDICATION :
• Conscious patient with gag reflex
• Foreign body obstruction in pharynx
• Coagulopathy
• Severe airway trauma
• Cervical spine injury

44. SIZE : FORMULA (ID)

45. SIZE CHART :

46. DEPTH :
• Placement in mid- trachea
• Adult male – 23 cm ; Adult female – 21 cm
• Pediatric :
• Oral et intubation : age /2 +12 cm
• . Nasal et intubation : age /2 +15 cm

47. EQUIPMENT :

48. TECHNIQUE :
• Before starting the procedure arrange all equipments and
positioning the patient ( sniffing ), pre oxygenation.
• Hold laryngoscope in left hand, insert scope into mouth with blade
directed to right tonsil..
• Once right tonsil is reached, sweep the blade to the midline
keeping the tongue on the left . This brings the epiglottis into view
• Advance the blade until it reaches the angle between the base of
the tongue and epiglottis.
• Lift the laryngoscope upwards and away from the nose-towards the
chest. This should bring the vocal cords into view. it may be
necessary for a colleague to press on the trachea to improve the
view of the larynx.

49. CONT….
• Place the ETT in the right hand. Keep the concavity of the tube
facing the right side of the mouth.
• Insert the tube watching it enter through the cords.
• Insert the tube just so the cuff has passed the cords and then inflate
the Cuff.
• listen for air entry at both apices and both axillae to ensure correct
placement using a stethoscope.
• cuff pressure between 20 and 30 cm H2O

50. PLACEMENT CONFIRMATION :
• UNDER VISION
• FOUR QUADRANT AUSCULATION
• CAPNOMETRY/ CAPNOGRAPHY
• VENTILATOR GRAPHS
• Chest x-ray

51. COMPLICATION :
• Laryngospasm
• Bronchospasm
• Esophageal intubation
• Pulmonary aspiration
• Tachycardia, arrhythmia, HTN
• Trauma to nasal, lip , tongue, teeth.

52. SUPRA GLOTTIC
AIRWAY

53. SGA :
• Supraglottic airway devices can be a life-saving tool in a 'cannot
intubate cannot ventilate' (CICV) scenario and are therefore an
essential part of the difficult and failed intubation time
• Also called extraglottic airway
• Supraglottic airway devices (SADs) are used to keep the
upper airway open to provide unobstructed ventilation.
Early (first-generation) SADs rapidly replaced
endotracheal intubation and face masks in > 40% of
general anesthesia cases due to their versatility and ease
of use.

55. ADVANTAGES :
• maintain upper airway patency (during general
anesthesia),
• ... allow for limited intermittent positive pressure
ventilation (IPPV),
• ... can be inserted/ placed atraumatically with a
relatively low skill set,
• ... and offer some degree of protection against the
aspiration of gastric contents

56. T
y
p
e
s

58. LMA CLASSIC :

59. SIZE CHART :

60. SIZE – CUFF PRESSURE :
• Size 1 : 4ml
• Size 1.5 : 7ml
• Size 2: 10ml
• Size 2.5 : 14ml
• Size 3: 20ml
• Size 4 : 30ml
• Size 5: 40ml

61. INSERTION TECHNIQUE :
• Before starting the procedure, gather all equipments
and take appropriate size of lma
• Check the Lma by inflate and deflation of cuff
• Positioning the patient – Extend the head, flex the neck
• Lubricate the mask at the posterior part of the mask…

62. CONT….
• Step 1 :
• Grasp the LMA by the tube,
holding it like a pen as near as
possible to the mask end.
• Place the tip of the LMA against
the inner surface of the patient's
upper teeth

63. CONT…..
Step 2:
Under direct vision:
-Press the mask tip upwards against the
hardpalate to filatten it out.
– Using the index finger, keep pressing
upwards as you advance the mask into
the pharynx to ensure the tip remains
flattened and avoids the tongue.

64. CONT….
•Step 3 :Keep the neck
flexed and head extended:
• -Press the mask into the
posterior pharyngeal wall
using the index finger.

65. CONT….
•Step 4:
• Continue pushing with your index
finger.
• . -Guide the mask downward
into position.

66. CONT….
•Step 5:
•Grasp the tube firmly with the
other hand
• -then withdraw your index finger
from the pharynx
• -Press genty downward with your
other hand to ensure the mask is fully
inserted.

67. CONT…
• Step 6 :
• Inflate the mask with the recommended
volume of air.
• Do not over-inflate the LMA.
• Do not touch the LMA tube while it is being
inflated unless the position is obviously
unstable. - Normally the mask should be
allowed to rise up slighthy out of the
hypopharynx as it is inflated to find it’s
correct.

68. VERIFY PLACEMENT OF THE LMA :
•Connect the LMA to a Bag-Valve Mask device
or low pressure ventilator
•Ventilate the patient while confirming equal
breath sounds over both lungs in all fields and
the absence of ventilatory sounds over the
epigastrium

69. SECURING THE LMA :
• . Insert a bite-block or roll of gauze to prevent
occlusion of the tube should the patient bite
down..
• Now the LMA can be secured utilizing the same
techniques as those employed in the securing of
an endotracheal tube.

70. PROBLEMS WITH LMA INSERTION
• Failure to press the deflated
mask up against the hard palate
or inadequate lubrication or
deflation can cause the mask tip
to fold back on itself.

71. PROBLEMS WITH LMA INSERTION :
• Once the mask tip has
started to fold over,
this may progress,
pushing the epiglottis
into its down-folded
position causing
mechanical obstruction

72. PROBLEMS WITH LMA INSERTION
• If the mask tip is defiated
forward it can push down
the epiglottis causing
obstruction . If the mask is
inadequately deflated it may
either
• -push down the epiglotis
• -penetrate the glottis.

75. Ambu aura gain LMA

78. COMBITUBE :

79. SIZE CHART :
SMALL (37 FR)
: SMALL
ADULTS
.
RUGULAR (41
FR) : ADULTS

89. TRACHEOSTOMY
• Trareation of a stoma at the skin surface which leads into the
trachea.
• Indication :
• Upper airway obstruction ( trauma, Foreign body, infection,
malignant lesion)
• Pulmonary ventilation
• Elective procedure
• Pulmonary toilet ( removal of secretion, Prevent aspiration)

90. SIZE :

91. TYPES OF TRACHEOSTOMY
•Cricothyroidotomy
•Open tracheostomy
•Percutaneous procedure

92. PROCEDURE

93. TECHNIQUE :

102. COMPLICATION :
• Bleeding
• Wound infection
• Tube dislodgement
• Tracheal stenosis
• Tracheal malacia
• Pneumothorax, granuloma
• Pneumomediastinum, dysphagia