adult airway day

7/29/2019 Adult Airway Day

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Adult Airway Day- October 20th,

2009

Station #1: Direct laryngoscopy, jet ventilation, flexible fiberoptic

intubation (Hoffman)

ENT direct laryngoscopes

First-line laryngoscopes: Dedo & Lindholm (for Hoffman, Pagedar),

Kleinsasser (other staff)

click for more information re: Dedo Laryngoscope
http://wiki.uiowa.edu/display/protocols/Dedo+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Dedo+Laryngoscope


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Lindholm Adolescent Scope -click here for more information re:Lindholm

Laryngoscope

Holinger anterior commissure scope- use for better exposure anteriorly

Jackson sliding laryngoscope- has removable component to facilitateinsertion of endotracheal tubes

Weerda laryngoscope- useful for supraglottic laryngectomies - click here

for more information re: Weerda Laryngoscope

Rudert laryngoscope- triangular shape (used in past by Dr. Trask)
http://wiki.uiowa.edu/display/protocols/Lindolm+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Lindolm+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Lindolm+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Weerda+Laryngoscopehttp://wiki.uiowa.edu/download/attachments/31752477/Weerda%20expanding%20laryngoscope.jpghttp://wiki.uiowa.edu/download/attachments/31752477/Holinger%20anterior%20commissure%20laryngoscope.jpghttp://wiki.uiowa.edu/download/attachments/31752477/Lindholm-Adolescent_0030.jpghttp://wiki.uiowa.edu/download/attachments/31752477/Dedo%20scope.jpghttp://wiki.uiowa.edu/display/protocols/Lindolm+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Lindolm+Laryngoscopehttp://wiki.uiowa.edu/display/protocols/Weerda+Laryngoscope


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Jet ventilation:

It is important to note that there are 2 different proximal jet cannulas

(adaptors that connect the laryngoscope to the jet ventilator), one for the Dedo

laryngoscope and one for the Kleinsasser laryngoscope. If the one you are

given doesnt seem to fit, ask for the other one!

Picture (below, left) shows a Kleinsasser laryngoscope with (A) = light

source adaptor and (B) = jet ventilation. Note that the jet ventilation always

goes off to the right because it always goes towards the side that anesthesia ison.

Picture (below, right) shows the jet ventilation machine (B).

Special intubation techniques1. Flexible fiberoptic laryngoscope for intubation (need to be at

least a __ size ETT)

Objectives

Recognize the different types of laryngoscopes and their uses.

Be able to set up a direct laryngoscope (Dedo) with light source and jetventilation

Appreciate the relationship of the anterior commissure scope with acuffed 5-0 MLT ET tube

Understand the role of the flexible fiberoptic scope in intubation.

Station #2: Rigid bronchoscopes, telescopes, and foreign body removal

(Funk)

Rigid bronchoscopes

Storz bronchoscopes (2): adult (6.5 & 7.5 x 43 cm; 8.5 available but in

separate location), adolescent (5.0 & 6.0 diameter x 40 cm)

If you can, try to use at least a 6.5 bronchoscope, because your optics

will be much better (with the corresponding 5.5 mm telescope); if you need to

use a 6.0 or smaller bronchoscope, you will unfortunately be forced to use a


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2.8 mm telescope.

Adult Pilling bronchoscope (7.0 & 8.0 diameter x 40 cm)

Mostly used for airway dilatations

Key maneuver: At level of vocal cords, rotate bronchoscope clockwise

90 degrees, so that longer edge of bevel is on the right. Advance scope w/bevel tip in center of larynx and shorter edge of bevel sliding against left cord,

to avoid catching and traumatizing right cord with bevel tip.

Two methods to place rigid bronchoscope: 1) Directly. 2) Use Jackson

sliding or anesthesia laryngoscopes to guide bronchoscope to level of vocalcords

Sample rigid bronchoscope:

Single combo unit with eyepiece, rubber telescope adaptor, and suction port.

Dr. Funk does not like this and uses the smaller individual units.

A. (Direct view) Bridge adaptor for endoscope vs. glass eyepiece vs.rubber telescope adaptor (for quick transfer b/w endoscope & optical forceps)

B. (Top) Prism with connection to light cable

C. (Oblique) Instrument guide for flexible suction catheter vs. jet

ventilation cannula (though we usually dont jet through bronchs)

D. (Bottom) Adaptor for respirator

Foreign body instrumentation

Storz optical forceps (preferred): adult or adolescent

Nonoptical forceps- rarely used

If there is concern about the foreign body fitting through bronchoscope,

you should brace the foreign body against end of bronchoscope and removeboth together as one unit. You do not want to shear the foreign body off the

end of the bronchoscope.

Objectives


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Be able to put together all the different parts of a bronchoscope and to

use optical forceps and rigid endoscope with the bronchoscope.

Station #3: Endotracheal tubes, laryngeal mask airways, anesthesia

laryngoscopes (Scamman)

Types of ET tubes: standard, MLT, oral RAE, nasal intubation, laser-

safe, EMG laryngeal monitoring, cuffed vs. uncuffed

Laryngeal mask airway (LMA)

Anesthesia direct laryngoscopes= MacIntosh, Miller, Wisconsin/Wis-

Hipple

In kids, the Wisconsin 1.5 blade provides a nice intermediate size bladebetween the more commonly available Miller 1.0 and Miller 2.0 straightblades.

Glide scope

Objectives

Recognize and understand when to use the different types of

endotracheal tubes, so that you can appropriately communicate with youranesthesia colleagues

Understand the role of the LMA and different anesthesia laryngoscopes

in airway management

Station #4: Adult emergency surgical airway (Pagedar)

Slash tracheotomy

Needle cricothyroidotomy (see separate handout): 18 gauge needle,

end of 3.0 ET tube, extension catheter (prn thick neck), syringe half-

filled with saline

Extra long Shiley tracheotomy tubes

Proximal vs. distal extension

Proximal vs. distal location of cuff


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Objectives

Understand the role of a slash tracheotomy and needle

cricothyroidotomy in emergency adult airway management. Be able to

perform these techniques if needed.

Understand the different types of extra long Shiley tracheotomy tubes

and when use of such a tube may be warranted.

click to see:

Needle Cricothyroidotomy

1. SUGGESTED READING

1. Benjamin B, Lindholm CE.[Ann Otol Rhinol Laryngol]Systematic direct laryngoscopy: the Lindholm laryngoscopes

2003 Sep;112(9 Pt 1):787-97.

2. Reading

3. Reading

Back to Top

Miller
http://wiki.uiowa.edu/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Benjamin%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://wiki.uiowa.edu/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lindholm%20CE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://wiki.uiowa.edu/display/protocols/Needle+Cricothyroidotomyhttp://wiki.uiowa.edu/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Benjamin%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://wiki.uiowa.edu/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lindholm%20CE%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://wiki.uiowa.edu/display/protocols/Adult+Airway+in+the+Operating+Room#AdultAirwayintheOperatingRoom-Top


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Size nside Length

(From Baseto Tip) mm

Model #

00, Premature 45 14 - 300FO - MIL - 00

0, Neonate 55 14 - 300FO - MIL - 0

1, Infant1.5, Infant Plus

80100

14 - 300FO - MIL 114 - 300FO - MIL - 1.5

2, Child 130 14 - 300FO - MIL - 2

3, Medium Adult 170 14 - 300FO - MIL - 3

4, Adult 180 14 - 300FO - MIL - 4

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