Advances in Supraglottic Airway

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Advances in Supraglottic Airway

• Dr. K. Sudarshan
• Consultant Anaesthetist
• Coimbatore

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Which ones qualify ?

• Should satisfy the following conditions

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

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1908 to date

• 1908- Hewitt Airway
• 1913- Connell
• 1915- Lumbard
• 1916 Mona Roberts
• 1923 - Phillips
• 1924 Poe
• 1930 Waters insufflation
• 1933 Guedel
• 1957- Fink vallecular
• 1957 Safar Airway
• 1977 Berman intubating
• 1982 Patil Syracuse
• 1983 Laryngeal Mask Archie brain
• 1985 Combitube

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Sir Frederic William Hewitt 1856 - 1916
A modified version of the original Hewitt airway
The original Hewitt airway as it appeared in
the February 15, 1908 issue of The Lancet.
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Dr.Arthur Guedel1883-1956
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Dr.Peter Safar
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Dr. Archie Brain
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COPA
COMBITUBE
NASOPHARYNGEAL AIRWAY
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Advancements

• New generation LMAs
• I gel
• Laryngeal Tube/ King LTS/ LTD
• Cobra plus tube

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Generally demonstrate

• Ability to be placed without direct visualization
• Better cardio vascular stability both during
  insertion and removal
• Minimal IOP and ICP changes
• Provide little protection against aspiration
• Contraindicated in full stomach patients

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Proseal LMA Supreme

• Has two separate tubes
• Three dimensional inflation of cuff
• Holds a better cuff seal pressure

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Flexible Ambu LMA

• Flexometallic tube
• Preformed angle
• Better placement
• Less incidence of dislodgement once placed
• More useful in head and neck surgery

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ILMA LMA C Trach

• Allows intubation with minimal head and neck
  manipulation
• Recommended in both difficult airway and
  Resuscitation algorithm
• C Trach allows intubation under direct vision

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

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Insertion Technique
I GEL INSERTION http//www.youtube.com/watch?v8
jqHCnThf1E
I GEL insertion in Lateral position http//www.yo
utube.com/watch?vuLtSojaSX6c
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Laryngeal Tube / KING LTS Tube
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King LTD Design
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King LTS-D Airway Design
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INSERTION STEPS

• Use lateral approach
• Introduce the tip into corner of mouth
• Advance behind the base of tongue
• Without exercising excessive force, advance until
  the base of the connector is aligned with teeth.
• Inflate the cuff

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FINAL POSITION
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Laryngeal tube Insetion.

• http//www.youtube.com/watch?vcBpU_fJe6ZA

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Cobra plus tube

• Distal end has softened openings
• Used for both spontaneous and controlled
  ventilation
• Serves as a rescue airway

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Streamlined liner of Pharyngeal airway - SILPA

• Cuffless
• Lines the pharynx
• Large internal volume Allows collection of
  secretion, minimize aspiration

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Summary

• Provides hands free maintenance of airway
• Can be used for both spontaneous and controlled
  ventilation
• Provide little protection against aspiration
• Useful in
• Routine anaesthesia
• emergency airway management
• Aid to intubation

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THANK YOU
doctorsudarshan_at_gmail.com