airwayequipment2-210902170038 2.pdf

BY DR.VYSHNAVI
ESIC MEDICAL COLLEGE & SUPERSPECIALITY
HOSPITAL
SANATH NAGAR, HYDERABAD
AIRWAY EQUIPMENT

FACE MASK
5
 It allows administration of
gases to the patient from a
breathing system, without
introducing any apparatus to
the patients mouth.
 Schimmelbusch mask
 Yankauers mask
 The modern face mask can be
made up of black rubber, clear
plastics, elastomeric material
 Parts of the face mask-
BODY,SEAL,CONNECTOR

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1) Anatomical mask : Has slightly
malleable rubber body, a sharp notch
for the nose and a curved chin
section.
2)Rendell-Baker-Soucek(RBS) mask
Designed for children of of less than
10 yrs. triangular in shape and has
less dead space .can be used in
tracheostomised patients.
3)Endoscopic mask : It has port or
diaphragm in the body to allow
fibroscope insertion.
4)scented mask: used for induction for
children.

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INDICATIONS
 Ventilation preceding endotracheal intubation:
 With anaesthesia circuits or circle systems
 With AMBU resuscitator bags
 Failed endotracheal intubation
 Awake or lightly sedated patient requiring a high inspired oxygen
concentration
CONTRAINDICATIONS
 Known increased risk of vomiting , regurgitation
 Known significant airway obstruction

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ADVANTAGES
 Requires less anaesthetic depth than tracheal tube or supraglottic
device.
 No need of muscle relaxants
 Lower incidence of sore throat
DISADVANTAGES
 Anesthesiologist’s hands are tied up
 Higher fresh gas flows are often needed.
 Gastric insufflation common if ventilatory pressures frequently exceed 20
cm H2O,
 Minimal protection from aspiration of regurgitated gastric contents
 Often more episodes of oxygen desaturation & require more

ORAL AND NASOPHARYNGEAL
AIRWAYS
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 Extends from lips to pharynx, fitting between tongue & posterior
pharyngeal wall.
 Its parts are:
 Flange : at the buccal end, to prevent it from
moving deeper into mouth & may also serve
to fix airway in place.
 Bite Portion : it is straight & fits between
upper and lower sets of teeth
 Curved portion : extends backwards to
correspond to the shape of tongue & palate.

Size Colour
000 Violet
00 Blue
0 Black
1 White
2 Green
3 Orange
4 Red
5 Yellow

Special airways
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 Guedel Airway: Guedel Airway Most
frequently used airway Has large flange &
reinforced bite portion with tubular channel for
air exchange & suctioning.
 Waters airway: Waters airway Metallic hollow
OPA with 2 holes at pharyngeal end for
attachment of oxygen line and suction Cheap,
reusable.
 Safar Airway: S-shaped OPA consisting of
two Guedel-type airways soldered together

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 Cuffed Oro- Cuffed Oro-Pharyngeal Airway
(COPA) Modification of Guedel`s Airway with
an inflatable cuff designed to seal the
oropharynx. Has an integral bite block & a
15mm connector for attachment of the
breathing circuit.
 Patil-Syracuse Endoscopic Airway
Designed to aid fiber-optic intubation. Made of
aluminium. Has lateral channels & a central
groove on the lingual surface to allow passage
of fiberscope. A slit in distal end allows
fiberscope to be manipulated in antero-
posterior direction but limits lateral movements.

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Berman Intubating Airway:
It is tubular along its entire length.
Open on 1 side so that it can be split & removed from around
a
tracheal tube.
Can be used as an oral airway or as an aid to fiberoptic or
blind
oro-tracheal intubation
Williams Airway Intubator:
Designed for blind tracheal intubation & can also be used for
fiberoptic intubation or as an oral airway.
Available in 2 sizes #9 & #10 which admit upto 8 & 8.5 mm
tracheal tube respectively.
The proximal half is cylindrical while distal half is open on
lingual surface.

INSERTION,USES,COMPLICATIONS
15
During insertion Pharyngeal & laryngeal reflexes should be
depressed before an oral airway is inserted, to avoid coughing &
laryngospasm.
Selecting the correct size is important. Correct size is estimated by
holding the airway next to pts mouth with the tip at the angle of
mandible.

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 USES
 Used to prevent patient from biting & occluding ETT.
 Protect the tongue from biting
 To facilitate suctioning
 To obtain better mask fit.
 COMPLICATIONS
 iatrogenic trauma and airway hyperreactivity
 Ulceration and necrosis of oropharyngeal structures
 Dental injury

NASOPHARYNGEAL AIRWAY
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 A nasal airway is better tolerated than oral airway if the
patient has intact airway reflexes.
 It extends from nose to pharynx
 The pharyngeal end should be below base of tongue
but above the epiglottis.
 When in place, an NPA is less stimulating than an OPA,
hence better tolerated in the awake, semicomatose, or
lightly anesthetized patient.
 In cases of oropharyngeal trauma, a nasal airway is
often preferable to an oral airway.

NASAL AIRWAY
Linder Nasopharyngeal Airway
It is plastic with large flange & flat distal end
and is supplied with introducer which has
balloon on its tip.
Cuffed Nasopharyngeal Airway
Binasal Airway
It consists of 2 nasal airways joined together
by an adaptor for attachment to the breathing
system.
Can be used to administer anesthesia.

 Uses: Indications:
 Tongue obstruction
 Inadequate oral opening
 Oral Surgery

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 Advantages :
 Well tolerated even in conscious patient
 Sizes : (Internal Diameter)
 Large adult :8-9 mm
 Small adult : 6-8 mm
Contraindications – haemorrhagic disorder
basilar skull fracture

LARYNGOSCOPES
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 A laryngoscope (larynx + scope) is a device that is used to visualize the
larynx and adjacent structures mainly for inserting a tube into
tracheobronchial tree.
 USES:Insertion of nasogastric tube and transesophageal echocardiac
probe
 Foreign body removal
 Upper airway lesion biopsy
 Visualizing and assessing the upper airway (vocal cords and larynx)
 TYPES: Direct Rigid laryngoscopes
 Indirect Rigid laryngoscopes which use fiberoptics, mirrors, prisms, etc.
 Video laryngoscopes – Rigid, Flexible
 Optical stylets
 Flexible fiberoptic endoscopes

LARYNGOSCOPES
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 RIGID LARYNGOSCOPE
 parts include handle and blade
 The handle is the part that is held in the hand
during use.
 It provides the power source for the light. Most
often this is from disposable batteries.
 Fibreoptic illuminated laryngoscope may use a
remote electrically operated light source.
 The handle is fitted with a hinge pin that fits a
slot on the base of the blade.
 Handles are available in variable sizes & have
rough surface for improved grip

TYPES OF BLADES
25
 There are several types of blades which may be
advantageous in particular situations.
 Macintosh Blade
The Macintosh blade is one of the most popular. The
tongue has a smooth, gentle curve that extends from the
base to the tip
Improved vision Macintosh blade
The Improved Vision (IV) Macintosh blade is similar to
the standard version except that the mid portion of the
tongue is concave to allow greater visualization of the
larynx.
Oxiport Macintosh (Mac/port)
The Oxiport Macintosh blade a,conventional Macintosh
blade with a tube added to deliver oxygen

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Tull Macintosh
 The Tull (suction) blade is a modified Macintosh
that has a suction port near the tip. The suction
channel extends next to the handle and has a
finger controlled valves so that suction canbe
controlled by the laryngoscopist
 Polio Blade
 The blade is at an obtuse angle to allow
intubation of patients in iron lung respirators or
body jackets
 Patients with obesity, breast hypertrophy,
kyphosis with severe barrel chest deformity,
short neck, or restricted neck mobility

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 Bizarri-Guiffrida Blade
 The Bizarri-Guiffrida blade is a modified Macintosh. The
flange is removed, except for a small part that encases the
light bulb.
 This was made to limit damage to the upper teeth.
 The blade is useful for patients with a limited mouth
opening, prominent incisors, receding mandible, short &
thick neck or anterior larynx.
 Flexible tip blade
 It has a hinged tip that is controlled by lever attached to the
proximal end of the blade When the lever is pushed towards
the handle, the tip of the blade is flexed.
 Eg: Mc-Coy.
 It may improve the chances of successful intubation by
elevating the epiglottis particularly in case of difficult
intubation. Less force and less stress response

VIDEO LARYNGOSCOPES
 The Bullard laryngoscope is useful in patients
who are difficult to intubate, including those in
whom head and neck movement is limited or
undesirable; those with limited mouth opening,
poor dentition, pharyngeal or laryngeal pathology,
or facial fractures; and the morbidly obese
 proved useful in children with Treacher Collins and
Pierre-Robin syndromes
 WuScope
 It combines a rigid, tubular blade & a flexible
fiberscope. .
 The fiberscope has short light & image transmitting
fibreoptic bundles & tip deflection contro

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VIDEO MACINTOSH INTUBATING
LARYNGOSCOPE
 It has macintosh blade attached to the
handle.
 The image- light bundle is threaded
through a small guide in the blade &
advanced 2/3 of the length of the blade.
 Provides better view than traditional
macintosh laryngoscope.
 GLIDE SCOPE
 It has a miniature digital camera underside
of a plastic blade. A light emitting device(
LED) mounted beside the camera provides
illumination. Blade has a 60° bend at the
midpoint The Glide Scope is available in
adult & pediatric size
 It causes less cervical movements than
macintosh blade

COMPLICATIONS OF
LARYNGOSCOPY
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 Dental injury/gum injury.
 Cervical spinal cord injury.
 Shock or burn.
 Swallowing/aspiration of foreign body.
 Laryngoscope malfunction.
 Circulatory changes.
 Damage to soft tissues and nerves
 Laryngoscope malfunctions
 TMJ dislocation

ENDOTRACHEAL TUBES
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 An endotracheal tube is one through which anesthetic gases and respiratory gases are conveyed
into and out of the trachea.
 It has tracheal & machine end
 The bevel is defined as the slanted part of the tube at the tracheal end.
 When, an opening in the tube is present on the opposite side of the bevel,it is called as Murphy's
tip
 Standard Markings On an ETT:
 The markings are situated on the bevel side above the cuff & are read from patient end to
machine end
 Type of the tube: Oral or nasal
 Size: ID in mm
 External diameter may also be indicated.
 Manufacturer's name or trade mark
 Tube has Graduated markings,showing the distance in cms from the patient end.
 Precautions are usually noted:Disposable/Do Not Reuse
 Radio-opaque lines may also be included at the patient end or along full length.

REQUIREMENTS OF IDEAL ET
TUBE
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1) Inertness
2) Smoothness of outer surface to avoid damage to mucosa
3) Inner surface should be smooth and non-wettable to prevent build
up of secretions.
4) Non-inflammable
5) Transparent
6) Easily sterilized
7) Non kinking
8) Sufficient strength to allow thin wall construction
9) Thermoplasticity to conform to anatomic passage and to be self
centering within the trachea.
10) Non reactive with lubricants or anesthetic agents
11) Latex free
12) Non injurious catheter tip
Currently used tubes are manufactured from synthetic rubber, plastic materials and
silicone.

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According to the type of the cuff: There are two types
1. High volume low pressure. : Cuff over a wide area of mucosa ; the
pressure exerted varies during the respiratory cycle , but on average is
lower than that produced by low-volume cuff.
2. low volume high pressure .: Produce a seal over a smaller areas of
tracheal mucosa cells and tend to exert a high pressure on the
mucosa ,reducing the capillary blood supply and rendering the cells
potentially ischemic.
GUIDELINES TO DETERMINE THE SIZE OF ETT:
Ideal tube in average Adult male – 8.5mm ID
Ideal tube in an average Adult female - 7.5mm ID.
Younger than 6 years ---3.5 + age in years/3 = ID in mm
Older than 6years ---- 4.5 + age in years / 4 = ID in mm

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 DEPTH OF INSERTION
 The tube should be in the middle third of the trachea with the head
in
 neutral position. The following calculations can be used.
 1) Length in cm = age/2 + 12
 2) Length in cm = weight in kg/5 + 12
 3) Length in cm = height in cms/10 + 12
 4) Length in cm = 3 × ID (mm)
 In adults, the tube should be passed until the cuff is 2.25 to 2.5cm

SPECIFIC TUBES
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 Cole tube:
 It is uncuffed ETT, designed for pediatric patients. The patient end is
smaller in diameter 2mm to 5mm..
for neonatal resuscitation but not for long term intubation.
 Spiral embedded tubes:
 Armored tube.
 metal or nylon spiral woven reinforcing wire covered both internally
and externally by rubber, PVC or silicone.
 A stylet is often needed for intubation.
 These tubes are esp useful in situations where the tube is likely to
be bent or compressed as in head & neck surgery
 Disadvantages:
 Insertion through nose & intubating LMA is difficult.
 Fixation is more difficult.
 If the patient bites the tube it will cause permanent deformity
resulting in obstruction of the tube.

SPECIAL TUBES
37
 Preformed tubes/Ring-Adair-Elwyn (RAE):
 There is a preformed bend to facilitate the head &
neck surgeries.
 The tubes are available in cuffed, uncuffed ,nasal and
oral version. Each tube has a rectangular mark at the
center of the bend. Distance from this mark to the distal
tip is printed on each tube.
 Laryngectomy tube:
 Designed for insertion into a tracheostomy site.
 The tube is preformed in a J configuration at the pt
end. This allows the part of the tube external to the
patient to be directed away from the surgical field.
 The tip may be short and/or without a bevel to avoid
inadvertent advancement into a bronchus.

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 Microlaryngeal tracheal surgery tube :
 4, 5 or 6mm
 Designed for microlaryngeal tracheal
surgery.
 The small diameter provides better surgical
access
 The problems with this tube are incomplete
exhalation & occlusion.
 Tubes with extra lumens:
 They are useful for respiratory gas
sampling, airway pressure monitoring,
injection of fluids and drugs & jet
ventilation.

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 Laser-shield II Tracheal Tube:
 It is designed for use with CO2 and
KTP lasers.
 Made from silicone with an inner
aluminium wrap and a smooth Teflon
outer coating.
 The cuff is not laser resistant &
contains methylene blue crystals and
should be inflated with water or saline
solution.
 Laser tubes:
 This is made of white rubber & has a
cuff-within-a cuff design.
 . The inner cuff is filled with air & outer
with water or saline.
 It is recommended for use with argon,
NdYAG, CO2 lasers.

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 Indications for ETT:
 Increased risk of vomiting or regurgitation
 High airway pressures anticipated
 Inaccessibility of airway during the procedure
 Need for prolonged controlled ventilation, lung isolation
 Advantages:A patent airway by oral, nasal or tracheal routes
 2. Controlled ventilation with up to 100% oxygen
 3. Ventilation with high airway pressure
 4. Airway protection from aspiration
 5. Removal of secretions
 6. Lung isolation
 7. Administration of medication including anesthetic gases

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 Disadvantages
 difficult to place than others
 Most stimulating to the patient during placement
 Coughing during and after extubation and emergence
 Usually requires neuromuscular blocking drugs to place
 Can lead to death if esophageal misplacement unrecognized
 Complications:
 Coughing and straining at emergence and extubation
 Post-extubation laryngospasm,
 Hypertension/tachycardia,
 Bronchospasm,
 Hoarseness of voice, sore throat
 Unrecognized esophageal intubation

• BOUGIE,STYLET,LIGHT WAND
• These encompass a series of solid or hollow,
semimalleable stylets that may be blindly
manipulated in to the trachea
• The Eschmann introducer(gum elastic bougie)
, was introduced in 1949. It is 60 cm long, 15Fr-
gauge, and angled 40degrees 3.5 cm from its
distal end
• It very helpful when the larynx cannot be
visualized with laryngoscopy
• Once it has entered the larynx and trachea
distinctive “clicking” feel is elicited as the tip
passes over the cartilaginous structures

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• The Frova Intubating Introducer is a
disposable device, with an optional “stiffening”
stylet and a hollow bore. The internal lumen
allows for the insufflation of oxygen, the detection
of carbon dioxide, and the use of a self-inflating
bulb to detect inadvertent esophageal placement.
• Light wand:malleable stylet with light emanating
from distal tip.
dim lights in OR and pass wand blindly
1.glow in lateral neck:tip in pyriform fossa
2.glow in anterior neck:correctly positioned in
trachea
3.glow diminishing slowly:tube in oesophagus.

DEVICES
 Supra glottic airway devices are those which are placed above the glottis and
thereby helps in providing adequate ventilation.
 Easy to operate.
 Helpful in difficult airway conditions.
 INDICATIONS
 Difficult intubation conditions
 Small procedures
 CPR
 Essential part of difficult airway trolley
 CONTRAINDICATIONS
 Airway edema,local pathology in upper airway
 Stridor,trismus,restricted mouth opening
 Active vomiting
 Caustic ingestion
 Pregnants,obese patients
 Reduced lung complaince

46
SUPRAGLOTTIC AIRWAY DEVICE- CLASSIFICATION
FIRST GENERATION
• Simple airway device
• Low pressure pharyngeal
seal
• May or may not protect
from aspiration
• Eg, cLMA, flexible LMA,
laryngeal tube, cobra
perilaryngeal airway,
LMA unique
SECOND GENERATION
• Specifically designed to
reduce risk
• High pressure pharyngeal
seal
• Reduce risk of aspiration
• May be more efficacious
in ventilation
• Eg, PLMA, Supreme LMA,
SLIPA, iGEL, laryngeal tube
suction
THIRD GENERATION
• Cuffless
• Two drain tubes
• Small bowl
• Eg, BASKA mask

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BASED ON SEALING MECHANISM
• Non directional non esophageal sealers: cLMA, flexible
LMA, ULMA
• directional non esophageal sealers: Fasttach
LMA,ALMa
• directional non esophageal sealers: Proseal LMA, LMA
supreme
CUFFED
PERILARYNGEAL
SEALER
• Without esophageal sealing: COPA, PAX
• With esophageal sealing: COMBITUBE, LT, LTS
CUFFED
PHARYNGEAL
SEALER
• Without esophageal sealing: Baska mask, Igel
• With esophageal sealing: SLIPA, AirQ-SP
CUFFLESS PRE
SHAPED SEALER

BASED ON NUMBER OF LUMEN
48
 SINGLE LUMEN DEVICES: LMA classic, LMA unique, LMA flexible, ILMA, C
trach, LAD, PAX,CPLA, LT, SLIPA
 DOUBLE LUMEN DEVICES: Proseal LMA, Combitube, LTS, Airway
management device (AMD)
 TRIPLE LUMEN DEVICES: Elisha airway device (EAD)

ADVANTAGES
49
 Increased speed and ease of placement.
 Less requirement of Inadequate positive expertise.
 Improved hemodynamic stability at induction and during emergence of
anesthesia.
 Minimal IOP and ICP changes during insertion.
 Increase airway tolerance.
 Lower frequency of coughing during emergence
DISADVANTAGES
 Vascular compression and nerve damage
 Sore throat
 Gastric aspiration chances are high
 High airway pressures.

The Laryngeal Mask Airway
Comprised of three main
components
– Airway Tube,mask,inflation line
Mask designed to conform to the
contours of the hypopharynx with
its lumen facing the laryngeal
opening.
Made of silicone, it can be
autoclaved and reused many
times.
Seal pressure =25cmH2O

TYPES OF LMA
51
 LMA UNIQUE
 Single use , PVC made , cheaper.
 Tube – stiffer , Cuff- less compliant.
 Less rise of intracuff presuure with N2O.
 More difficult to insert.
 Size same as cLMA.
 FLEXIBLE LMA
 Flexometallic tube- narrower & longer.
 Has a rigid preformed angle at the cuff.
 Seal pressure=20cmH2O
 Introducer helps to stabilize the airway tube during insertion & it is
removed once mask is in place.
 It has a less incidence of dislodgement once placed.
 More useful in head & neck surgeries, ENT and upper torso
procedures where need to reposition the airway is prevalent

TYPES OF LMA
52
 AMBU AURA LARYNGEAL MASK
 Ambu Auraonce- single-use LM with a preformed curve.
 The Ambu Aura40 is the reusable, silicone version of the Ambu
AuraOnce.
 The Ambu Aura-i designed to facilitate intubation like ILMA.
 Three parts- an airway tube, a mount area, and a bowl including
the inflatable cuff..
 A reinforced tip reduces the risk of the device folding back during
insertion.
 SOFT SEAL LARYNGEAL MASK
 similar to the single-use LMA.
 The ventilation orifice is wider and Cuff is more elliptical..
 A maximum intracuff pressure of 60 cm H2O is recommended.
 may be used as an intubation conduit.

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 PERI LARYNGEAL AIRWAY(COBRA)
 single use, PVC made, latex free .
 It has a breathing tube with a large inner diameter
 Novel head design- Grill of soft bar with Cobra head
shape.Lies infront of laryngeal inlet.
 Tip deflects epiglottis.
 Bars allow ventilation & instrumentation.
 I-LMA
 A modification of the c-LMA.
 A rigid (stainless steel) anatomically curved,short & wide
bored shaft that follows the anatomical curve of the palate
and the post pharyngeal wall.
 An epiglottic elevator bar at the mask aperture. Armoured
flexible ET tube with a longitudinal and a horizontal black
line coincides with the epiglottic elevating bar.
 The Stabilizer Rod of 25cm.
 Seal pressure=60cmof H20

PRO-SEAL LMA
54
 Reusable , silicon made , modification of c-LMA
 Modifications:-
 (i) oesophageal drain tube
 (ii) posterior inflatable cuff
 (iii) reinforced airway tube
 (iv) integral bite block
 (v) introducer
 Higher leak pressure(35cm of H2O) than c-LMA(25cm of
H2O).
 Size- in 7 sizes (1-5) like the C-LMA with drainage tube
of
 8,10,10,14,16,16&18 Fr respectively

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 LMA SUPREME
 Single use, PVC made 2nd generation LMA.
 Has features of P-LMA, I-LMA & LMA unique.
 (i) Single use , PVC
 (iii) Oesophageal drain tube
 (iv) Preformed semi-rigid tube
 Pharyngeal seal is intermediate between cLMA and PLMA(26–30 cm
H2O)
 LMA C-TRAC
 Enables combined ventilation, visualization, and
 intubation.
 High first attempt intubation success rate of 91%.
 Fiberoptic technology allows real time visualization of the glottic
opening and of the ET tube passing through the vocal cords.
 Ideal in rescue/difficult airway situations .
 Completely portable and wireless system less weight

LARYNGEAL TUBE
 Laryngeal tube introduced in 1999.
 Consists of silicon reusable airway tube with two cuffs
(pharyngeal&esophageal) and a single ballon for pressure control
and a 15 mm standard male adapter.
 Short & J shaped ; blind tip,average diameter 11.5mm. Sizes -
0,1,2,3,4,5.
 Both cuffs are high volume & low pressure to avoid ischemic
damage
 Wedge shaped block closes the tip of the tube which divert the air
into trachea
 Single inflation line
 2 or 3 side eyelets- for collateral ventilation

LARYNGEAL SUCTION TUBE
 Laryngeal tube suction(LTS) is a double lumen silicon tube .
 2nd lumen helps in gastric suctioning & insertion of nasogastric
tube.

STREAMLINED LINER OF THE
PHARYNX AIRWAY
 SLIPA –named because looks like a slipper.
 Developed by DR.Donald miller.
 Low cost
 Commercially available since 2004.


 It is a soft plastic with an anatomically preformed shape that lines
pharynx.
 Parts –hollow , blow molded chamber shaped lile a boot with a >toe
>bridge >heel
 Design aims at relieving pressure & prevents damage to hypoglossal &
rec laryngeal nerve.
 Minimization of aspiration risk with out cuff necessicite doubling in size
of devices.
• Sizes – 47,49,51>females:53,55,57>males.
• ADVANTAGES
• Simple device.
• Inexpensive.
• Less risk of aspiration compared to other SGA.
• Doesn’t require relaxant or laryngoscope.
• No cuff.
• Controlled or spontaneous ventilation.
• Less incidence of sore throat.
• DISADVANTAGE--selection of correct size.(width of thyroid cartilage )

ELISHA AIRWAY DEVICE
 Reusable one.
 Functions ventilation,
 blind or fiberoptic intubation without interruption of
ventilation,
 gastric tube insertion.
 Main advantage : drain gastric contents by gastric tube.

PHARYNGEAL AIRWAY XPRESS
• Paxpressa
• Used during routine procedurs
• Parts curved tube with anatomically shaped grilled tip,
a large oropharyngeal cuff,
open 3.5cm hooded window between these two.
• Hood is to lift the epiglottis forward.
 Blind insertion. Flexible gilled tip fits into hypopharynx.
 High volume low pressure cuff placed below uvula better airway seal.
 Used in spontaneous or controlled ventilation.
 Main advantage fiberoptic bronchoscope or 7.5 size ET tube can be
inserted

I-GEL
 Unique , single use.
 Made from thermoplastic elastometer.
 Designed non inflatable,anatomic seal of
airway structures.
 Available in 3 sizes (red,green,yellow).
ADVANTAGES
Ease of insertion,
Less incidence of trauma,
Gastric channel,
Integral bite block reduces the possibility of airway
obstruction,
Less incidence of down folding of epiglottis &
obstruction.

COMBITUBES
• This design, named the Tracheal Esophageal
Combitube, is functional if introduced into the
esophagus (ventilation being achieved through the
esophageal lumen, via the hypopharyngeal
perforations) or in the trachea (ventilation being
achieved through the tracheal lumen, via the distal
aperture).
• The device is available in two sizes: the 41Fr size is
used for larger adults (height >5.5 feet) and the 37Fr
size is used for adults 4 to 6 feet tall
• Though a single-use device, Combitube reprocessing
and reuse has been reported
• The oropharyngeal balloon is inflated with 100 mL of
air through a blue plastic pilot balloon (85 mL in the
small adult size) while the distal cuff is inflated with 5

 USES
 massive upper gastrointestinal bleeding or vomiting,
 a rescue device in failed rapid-sequence induction or
unanticipated difficult intubation.
 useful in the morbidly obese, in acute bronchospasm, during
cardiopulmonary resuscitation, and
 for prolonged ventilation after airway rescue.
 rapid airway control,
 airway protection from regurgitation,
 ease of use by the inexperienced operator, no requirement to
visualize the larynx, and being able to maintain the neck in a
neutral position

AIR Q-SP
68
• The Air-Q is a new supraglottic airway
device
• designed for airway maintenance and
also as a conduit for endotracheal
intubation during general anaesthesia.
• advantage of the device design is that
conventional PVC endotracheal tube can
be passed through the Air-Q ILA to
intubate the trachea (up to 7.5 and 8.5
mm ID through Air-Q size 3.5 and 4.5,
respectively) without the use of
conventional laryngoscope.
• Armoured endotracheal tubes can also
be used with Air-Q ILA as conduit.

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