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Advances in Supraglottic Airway Dr. K. Sudarshan Consultant Anaesthetist Coimbatore.

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Presentation on theme: "Advances in Supraglottic Airway Dr. K. Sudarshan Consultant Anaesthetist Coimbatore."— Presentation transcript:

1 Advances in Supraglottic Airway Dr. K. Sudarshan Consultant Anaesthetist Coimbatore

2 doctorsudarshan@gmail.com Which ones qualify ? Should satisfy the following conditions

3 doctorsudarshan@gmail.com 1.Placed above the vocal cord level 2.Those devices which 2.Those devices which allow hands-free maintenance of an open airway 3. A 3. Allows spontaneous or assisted ventilation

4 doctorsudarshan@gmail.com 1908- Hewitt Airway 1908- Hewitt Airway 1913- Connell 1913- Connell 1915- Lumbard 1915- Lumbard 1916 – Mona Roberts 1916 – Mona Roberts 1923 - Phillips 1923 - Phillips 1924 – Poe 1924 – Poe 1930 – Waters insufflation 1930 – Waters insufflation 1933 – Guedel 1933 – Guedel 1957- Fink vallecular 1957- Fink vallecular 1957 – Safar Airway 1957 – Safar Airway 1977 – Berman intubating 1977 – Berman intubating 1982 – Patil Syracuse 1982 – Patil Syracuse 1983 – Laryngeal Mask – Archie brain 1983 – Laryngeal Mask – Archie brain 1985 – Combitube 1985 – Combitube 1908 to date

5 doctorsudarshan@gmail.com Sir Frederic William Hewitt 1856 - 1916 The original Hewitt airway as it appeared in the February 15, 1908 issue of The Lancet. A modified version of the original Hewitt airway

6 doctorsudarshan@gmail.com Dr.Arthur Guedel 1883-1956

7 doctorsudarshan@gmail.com Dr.Peter Safar

8 doctorsudarshan@gmail.com Dr. Archie Brain

9 doctorsudarshan@gmail.com NASOPHARYNGEAL AIRWAY COPACOMBITUBE

10 doctorsudarshan@gmail.com Advancements New generation LMAs New generation LMAs I gel I gel Laryngeal Tube/ King LTS/ LTD Laryngeal Tube/ King LTS/ LTD Cobra plus tube Cobra plus tube

11 doctorsudarshan@gmail.com Generally demonstrate Ability to be placed without direct visualization Ability to be placed without direct visualization Better cardio vascular stability both during insertion and removal Better cardio vascular stability both during insertion and removal Minimal IOP and ICP changes Minimal IOP and ICP changes Provide little protection against aspiration Provide little protection against aspiration Contraindicated in full stomach patients Contraindicated in full stomach patients

12 doctorsudarshan@gmail.com Proseal & LMA Supreme Has two separate tubes Has two separate tubes Three dimensional inflation of cuff Three dimensional inflation of cuff Holds a better cuff seal pressure Holds a better cuff seal pressure

13 doctorsudarshan@gmail.com Flexible & Ambu LMA Flexometallic tube Flexometallic tube Preformed angle Preformed angle Better placement Better placement Less incidence of dislodgement once placed Less incidence of dislodgement once placed More useful in head and neck surgery More useful in head and neck surgery

14 doctorsudarshan@gmail.com ILMA & LMA C Trach Allows intubation with minimal head and neck manipulation Allows intubation with minimal head and neck manipulation Recommended in both difficult airway and Resuscitation algorithm Recommended in both difficult airway and Resuscitation algorithm C Trach allows intubation under direct vision C Trach allows intubation under direct vision

15 doctorsudarshan@gmail.com

16 Single use, cuffless Single use, cuffless Integral gastric channel Integral gastric channel Epiglottic blocking ridge Epiglottic blocking ridge Moulding feature Moulding feature

17 doctorsudarshan@gmail.com Insertion Technique I GEL INSERTION http://www.youtube.com/watch?v=8jqHCnThf1E I GEL insertion in Lateral position http://www.youtube.com/watch?v=uLtSojaSX6c

18 doctorsudarshan@gmail.com Laryngeal Tube / KING LTS Tube

19 doctorsudarshan@gmail.com King LTD Design

20 doctorsudarshan@gmail.com King LTS-D Airway Design

21 doctorsudarshan@gmail.com INSERTION STEPS Use lateral approach Use lateral approach Introduce the tip into corner of mouth Introduce the tip into corner of mouth Advance behind the base of tongue Advance behind the base of tongue Without exercising excessive force, advance until the base of the connector is aligned with teeth. Without exercising excessive force, advance until the base of the connector is aligned with teeth. Inflate the cuff Inflate the cuff

22 doctorsudarshan@gmail.com FINAL POSITION

23 doctorsudarshan@gmail.com Laryngeal tube Insetion. Laryngeal tube Insetion. http://www.youtube.com/watch?v=cBpU_fJ e6ZA http://www.youtube.com/watch?v=cBpU_fJ e6ZA

24 doctorsudarshan@gmail.com Cobra plus tube Distal end has softened openings Distal end has softened openings Used for both spontaneous and controlled ventilation Used for both spontaneous and controlled ventilation Serves as a rescue airway Serves as a rescue airway

25 doctorsudarshan@gmail.com Streamlined liner of Pharyngeal airway - SILPA Cuffless Cuffless Lines the pharynx Lines the pharynx Large internal volume – Allows collection of secretion, minimize aspiration Large internal volume – Allows collection of secretion, minimize aspiration

26 doctorsudarshan@gmail.com Summary Provides hands free maintenance of airway Provides hands free maintenance of airway Can be used for both spontaneous and controlled ventilation Can be used for both spontaneous and controlled ventilation Provide little protection against aspiration Provide little protection against aspiration Useful in Useful in Routine anaesthesia Routine anaesthesia emergency airway management emergency airway management Aid to intubation Aid to intubation

27 doctorsudarshan@gmail.com THANK YOU


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