Alternative airway devices

Dr Sadia Farhan

Multilumen Airways

•Inserted blindly•Proven to secure airway and allow for

better ventilation.•Two devices:

▫Pharyngotracheal lumen airway ▫Combitube

Multilumen Airways

•Combitube ▫Long tube▫Can be used

for ventilation whether it is inserted into the esophagus or trachea

Multilumen Airways• Indications

▫ Unresponsive, apneic patients with no gag reflex in whom intubation is not possible Cannot be used in

children younger than 16 years

Only use for patients between 5 ft and 7 ft tall.

• Contraindications▫ Esophageal trauma▫ Known pathologic

condition of the esophagus

▫ Ingestion of a caustic substance

Multilumen Airways

• Advantages▫ Ventilation in

esophagus or trachea ▫ Insertion is easier

than ET intubation▫ Minimal cervical spine

movement▫ No mask seal ▫ Airway patency

• Disadvantages▫ Wrong port results in

no pulmonary ventilation

▫ Risk of aspiration▫ Intubating the trachea

via direct laryngoscopy is challenging.

Complications of Multilumen Airways

•Unrecognized displacement into esophagus

•Laryngospasm, vomiting, hypoventilation •Pharyngeal or esophageal trauma •Ventilation may be difficult if the

pharyngeal balloon pushes the epiglottis over the glottic opening.

Insertion Techniques •Combitube

consists of:▫Single tube with

two lumens▫Two balloons▫Two ventilation

attachments•Before insertion,

prepare equipment.

Insertion Techniques

•Head should be in a neutral position▫Insert thumb into the mouth and lift the

jaw.•Insert device until incisors are between

the two black lines•Two valves must be inflated sequentially.

Insertion Techniques

•After inflation of balloons, begin to ventilate▫Through the longer (blue) tube first

•Observe for chest rise and auscultate.▫If there are no breath sounds, switch to the

shorter (clear) tube.•Continuously monitor ventilation.

Laryngeal Mask Airway (LMA)•Option for patients who:

▫Require more support than bag-mask ▫Do not require ET intubation

•Conduit from glottic opening to ventilation device

Laryngeal Mask Airway (LMA)•Surrounds

larynx opening with an inflatable cuff ▫Cuff conforms

to airway contours, forms airtight seal

Laryngeal Mask Airway (LMA)

•Indications and contraindications ▫Alternative to bag-mask ventilation▫Less effective in obese patients▫Pregnant patients and patients with a hiatal

hernia are at risk for regurgitation.▫Ineffective with patients requiring high

pulmonary pressures

Laryngeal Mask Airway (LMA)• Advantages

▫ Better ventilation ▫ No continual

maintenance of a mask seal

▫ No laryngoscopy▫ Less risk of trauma ▫ Protection from

secretions

• Disadvantages▫ No protection against

aspiration▫ Air may be insufflated

into the stomach

Complications of Using LMA

•Involve regurgitation and aspiration ▫Weigh against risk of hypoventilation

•Hypoventilation of patients who require high ventilatory pressures can occur.

•Upper airway swelling has been reported.

Equipment for LMA

•Seven sizes; based on the patient weight•Consists of tube and inflatable mask cuff•Two bars at opening prevent occlusion•Proximal end is fitted with standard

adapter

Equipment for LMA•Cuff has a one-

way valve assembly

•6.0-mm ET tube can be passed through size 3 or 4 LMA

King LT Airway•Latex-free, single-

use, single-lumen▫Positive-pressure

ventilation for apneic patients

▫Maintains airway in spontaneously breathing patients who need advanced management

.

King LT Airway

•Curved tube with ventilation ports between two inflatable cuffs▫Can be inserted

more easily than the Combitube

King LT Airway

•Two types:▫King LT-D: used

for adults and children

▫King LTS-D: used for adults Five sizes of each

type

King LT Airway

•King LT-D and LTS-D share many features:▫Proximal pharyngeal cuff, distal cuff,

ventilation outlets ▫ET tube introducer can be inserted through

the tube▫Distal end: closed in LT-D; open in LTS-D

King LT Airway

• Indications▫ Alternative to bag-

mask ventilation ▫ Same considerations

as Combitube

• Contraindications▫ Patients with an intact

gag reflex▫ Patients with known

esophageal disease▫ Patients who have

ingested a caustic substance

Complications of the King LT Airway

•Laryngospasm, vomiting, hypoventilation•Trauma from improper insertion

technique•Pharyngeal balloon may push the

epiglottis over the glottic opening ▫May make ventilation difficult

Insertion Technique

•Patient’s height and weight determine size you should use.

Cobra Perilaryngeal Airway (CobraPLA)

•Shape lets device: ▫Slide easily along

the hard palate▫Hold airway’s soft

tissue away from the laryngeal inlet

•Available in eight sizes

Cobra Perilaryngeal Airway (CobraPLA)

• Indications▫ Usage similar to other

supraglottic airway devices

▫ Can be used in pediatric patients

▫ Does not protect against aspiration

• Contraindications▫ Risk for aspiration▫ Risk for massive

trauma to oral cavity

Contraindications and Complications

• Complications▫ Laryngospasm may occur with intact gag reflex▫ Cuff inflation may cause tongue to disrupt seal.▫ Patient cannot be ventilated if device is too small.