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