2 Multilumen Airways Inserted blindly Proven to secure airway and allow for better ventilation.Two devices:Pharyngotracheal lumen airwayCombitube
3 Multilumen Airways Combitube Long tube Can be used for ventilation whether it is inserted into the esophagus or trachea
4 Multilumen Airways Indications Contraindications Unresponsive, apneic patients with no gag reflex in whom intubation is not possibleCannot be used in children younger than 16 yearsOnly use for patients between 5 ft and 7 ft tall.ContraindicationsEsophageal traumaKnown pathologic condition of the esophagusIngestion of a caustic substance
5 Multilumen Airways Disadvantages Advantages Wrong port results in no pulmonary ventilationRisk of aspirationIntubating the trachea via direct laryngoscopy is challenging.AdvantagesVentilation in esophagus or tracheaInsertion is easier than ET intubationMinimal cervical spine movementNo mask sealAirway patency
6 Complications of Multilumen Airways Unrecognized displacement into esophagusLaryngospasm, vomiting, hypoventilationPharyngeal or esophageal traumaVentilation may be difficult if the pharyngeal balloon pushes the epiglottis over the glottic opening.
7 Insertion Techniques Combitube consists of: Single tube with two lumensTwo balloonsTwo ventilation attachmentsBefore insertion, prepare equipment.
8 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 linesTwo valves must be inflated sequentially.
9 Insertion Techniques After inflation of balloons, begin to ventilate Through the longer (blue) tube firstObserve for chest rise and auscultate.If there are no breath sounds, switch to the shorter (clear) tube.Continuously monitor ventilation.
10 Laryngeal Mask Airway (LMA) Option for patients who:Require more support than bag-maskDo not require ET intubationConduit from glottic opening to ventilation device
11 Laryngeal Mask Airway (LMA) Surrounds larynx opening with an inflatable cuffCuff conforms to airway contours, forms airtight seal
12 Laryngeal Mask Airway (LMA) Indications and contraindicationsAlternative to bag-mask ventilationLess effective in obese patientsPregnant patients and patients with a hiatal hernia are at risk for regurgitation.Ineffective with patients requiring high pulmonary pressures
13 Laryngeal Mask Airway (LMA) AdvantagesBetter ventilationNo continual maintenance of a mask sealNo laryngoscopyLess risk of traumaProtection from secretionsDisadvantagesNo protection against aspirationAir may be insufflated into the stomach
14 Complications of Using LMA Involve regurgitation and aspirationWeigh against risk of hypoventilationHypoventilation of patients who require high ventilatory pressures can occur.Upper airway swelling has been reported.
15 Equipment for LMA Seven sizes; based on the patient weight Consists of tube and inflatable mask cuffTwo bars at opening prevent occlusionProximal end is fitted with standard adapter
16 Equipment for LMA Cuff has a one-way valve assembly 6.0-mm ET tube can be passed through size 3 or 4 LMA
17 King LT Airway Latex-free, single- use, single-lumen Positive-pressure ventilation for apneic patientsMaintains airway in spontaneously breathing patients who need advanced management.
18 King LT AirwayCurved tube with ventilation ports between two inflatable cuffsCan be inserted more easily than the Combitube
19 King LT Airway Two types: King LT-D: used for adults and children King LTS-D: used for adultsFive sizes of each type
20 King LT Airway King LT-D and LTS-D share many features: Proximal pharyngeal cuff, distal cuff, ventilation outletsET tube introducer can be inserted through the tubeDistal end: closed in LT-D; open in LTS-D
21 King LT Airway Indications Contraindications Alternative to bag-mask ventilationSame considerations as CombitubeContraindicationsPatients with an intact gag reflexPatients with known esophageal diseasePatients who have ingested a caustic substance
22 Complications of the King LT Airway Laryngospasm, vomiting, hypoventilationTrauma from improper insertion techniquePharyngeal balloon may push the epiglottis over the glottic openingMay make ventilation difficult
23 Insertion TechniquePatient’s height and weight determine size you should use.
24 Cobra Perilaryngeal Airway (CobraPLA) Shape lets device:Slide easily along the hard palateHold airway’s soft tissue away from the laryngeal inletAvailable in eight sizes
25 Cobra Perilaryngeal Airway (CobraPLA) IndicationsUsage similar to other supraglottic airway devicesCan be used in pediatric patientsDoes not protect against aspirationContraindicationsRisk for aspirationRisk for massive trauma to oral cavity
26 Contraindications and Complications Laryngospasm may occur with intact gag reflexCuff inflation may cause tongue to disrupt seal.Patient cannot be ventilated if device is too small.