Alternative Airway Devices and Adjuncts -NEET PG Anesthesia
Feb 13, 2023
Alternative Airway Devices and Adjuncts are important topics for the NEET PG exam because they play a critical role in the management of airway emergencies. Proper selection and use of alternative airway devices and adjuncts can make the difference between life and death for patients who are experiencing airway obstruction, respiratory distress, or cardiac arrest.
In order to effectively manage airway emergencies, healthcare providers must have a thorough understanding of the different types of alternative airway devices and adjuncts that are available, their indications for use, and the proper techniques for their insertion and maintenance.
This includes knowledge of various devices such as laryngeal mask airway (LMA), supraglottic airway devices (SGDs), and endotracheal tubes, as well as adjuncts such as oxygen masks, bag-valve-mask (BVM) devices, and chest compression devices.
In summary, the knowledge and skills related to Alternative Airway Devices and Adjuncts is essential for healthcare professionals, and is therefore an important topic in the NEET PG exam.
To ensure that your preparation for this important topic is complete, read this medical notes blog.
If the equipment is above the glottis: Supraglottic.
If the equipment is below the glottis: Infraglottic.
Laryngeal mask airway
AIRWAY MANEUVERS TO OPEN AN OBSTRUCTED AIRWAY
Head tilt and chin lift
Pulls the tongue away from the airway and removes the obstruction.
In trauma patients with suspected neck or cervical injuries, this maneuver is not performed.
Jaw lift or Jaw thrust
Forward protrusion of jaw. Head is in neutral position and forward protrusion of the jaw with head kept stabilized in both hands.
For trauma patients, since head tilt and chin lift maneuver involve neck movement.
Therefore, we perform jaw lift maneuver in order to open airway.
Simple Airway Adjunct
Most common is Guedel’s airway. It is made up of rigid plastic. The size is determined from the angle of the lips to the angle of the mandible. It is inserted in an upside down position with a tip facing the roof of the mouth. Once it is half inserted, it is rotated to 180°.
In a conscious patient with compromised airway, we use nasopharyngeal airway. It is made up of soft silicon. The size is determined from the tip of the nose/ nostril to ear lobe. We insert it through the nasal cavity bevel facing the septum. It is a comfortable device. It can be inserted in a conscious patient.
ENDOTRACHEAL INTUBATION (ET)
ET tube through oral cavity: Need Laryngoscope
Popular used Laryngoscope is Mcintosh (Curved Blade Laryngoscope)
Parts of ET tube
Glottic opening: Beveled to give a better visualization of glottic opening.
Murphy’s eye: Alternate opening, if the terminal opening gets blocked or obstructed.
Cuff: Creates a seal in trachea for positive pressure ventilation. It also prevents any upper secretions of the upper airway to go into lower airways, thus preventing the aspiration.
Black mark: Left at the glottic opening, for the correct positioning of the tube. The ET tube is kept 3-4 cm above the carina.
Universal connector: Connects to the circuit.
STEPS OF LARYNGOSCOPY AND INTUBATION
Positioning: Morning sniffing position/ barking dog position
Hold the laryngoscope in the left hand.
Introduce the laryngoscope from the right angle of mouth. Sweep the tongue from the middle to the left side.
Visualize epiglottis and Arytenoid/ Vallecula.
Hinge the tip of the Laryngoscope in Vallecula and lift it.
Inflate the cuff after introducing the tube.
Check for the right position either through auscultation or capnography.
Fix the tube.
SOME SPECIAL TUBES
Flexometallic/ Armored tube/ Reinforced tube
Inner diameter reinforced by metallic wire to make it kink resistant.
Indications of using flexometallic tube
Head and neck surgery
Prone position surgery
Differences b/w Flexometallic tube and standard ET tube. In flexometallic tube
Universal connector is fixed.
Highly malleable (rigid) so always needs a stylet during insertion.
No radio opaque line required.
It is kink resistant.
Double lumen tube
It has 2 lumens
Bronchus lumen: Going into either bronchus.
Tracheal lumen: Going into trachea.
It is used for one lung ventilation.
Indications: Lung separation & Thoracic surgery.
Ring - Aladdin – Elwyn tube.
Specially designed for cleft-lip palate surgery.
Bent in one direction either upward or lower direction.
Not popular these days.
Used in pediatric < 7-9 years to prevent subglottic edema/ injury.
Miller/straight blade laryngoscope is used in pediatric cases.
Indications of intubation
During general anesthesia
For positive pressure ventilation
To protect the airway from aspiration
For pulmonary toileting
Laryngeal Mask Airway (LMA): Supraglottic
Designed by Dr Archie Brain
Supraglottic airway device
Easy and fast to insert
Not a definitive device
Tip of classical LMA goes into hypopharynx (not glottic opening)
Aspiration cannot be prevented
ET tube is the best device to prevent aspiration, cuff pressure necessary is 20-25 cm H2O/ 18-20 mmHg
In this image the tip of cuff goes to hypopharynx and rest on hypopharynx
The opening on ventral side will fall on the glottic opening
Pro seal LMA
Has inflatable cuff
Cobra peri laryngeal airway
Fast track LMA or intubating LMA
There is single tube present, which can be used for positive pressure ventilation only
Demerit: Cannot prevent aspiration
They have an airway tube and a gastric tube
They create a better real than first generation supraglottic device (more protective against aspiration).
Used for positive pressure ventilation and additional used
Comparable to endotracheal tube to prevent aspiration
Sizes of LMA (Classic and Proseal)
Weight in Kg
Size of LMA
< 5 kg
> 70 kg
> 100 kg
I-gel: Non inflatable has a special polymer, this swells in the oral cavity and seals over the glottic cavity.
It has airway and gastric tube through which can pass Ryle’s tube
LMA supreme: Tube is curved so that it facilitates in the oral cavity.
Cervical spine injury
In emergency: Manual in-line stabilization (MILS) of head and Oro-tracheal intubation.
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