#Infraglottic airways

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1. INFRAGLOTTIC AIRWAYS ARTIFICIAL AIRWAYS Dr Nisar Ahmed Arain Assistant Professor Anesthesia/Critical Care/ER

2. Infraglottic Airways Purpose Lift the tongue & epiglottis away from the posterior pharyngeal wall & prevent them from obstructing the space above larynx

3. OBJECTIVES - Oropharyngeal - Nasopharyngeal - Endotracheal Tubes - Tracheostomy tubes

4. Oropharyngeal a irway Indications – – -- Maintain airway in the unconscious patient -- Protects an Endotracheal Tube from being bitten -- Facilitates Airway Suctioning

5. Guedal Airway

6. Berman Airway -- It has a center support & open sides -- Has a flange at the buccal end

7. Ovassapian Airway -- The Ovassapian airway is used to facilitate fiber-optic intubation. -- Overall shape is similar to a Geudal airway, but is open on the top -- A tubular shaped guide in the center facilitates passage of fiber-optic laryngoscope.

8. Williams Intubating Airway -- This is designed to facilitate fiber-optic intubation. -- It is similar in profile to the guedal airway, it is open on the distal half, and cylindical at the proximal portion. -- It is only available in 2 sizes 9 cm and 10 cm.

9. -- A Guedal airway with an inflatable cuff to seal the oropharynx -- A 15 mm connector to attach to breathing circuit -- Cuff inflated with 25 to 40 cc air --Cuffed Oropharyngeal Airway (COPA)

10. LT Oro pharyngeal Airway -- This has a 15 mm adaptor for connection to the anesthesia circuit. -- Come in different sizes and are color coded. -- They are not available in pediatric sizes.

11. Nasopharyngeal Airway Indications – • – Airway maintenance If Oral Airway placement is difficult Nasotracheal intubation is the answer Complications – – – – - Esophageal intubation (if too long) - La r y ngo s p asm - Vomiting - Nasal mucosa injury and -S econdary blood aspiration

12. ENDO T RACHEAL TUBES

13. Determining Sizes Internal Diameter (ID) • Newborns - <28 wks (<1000 g): 2.5 mm -28-34 wks (1000-2000 grams): 3.0 mm - 34-38 wks (2000-3000 grams): 3.5 mm - >38 wks (>3000 grams): 3.5 to 4.0 mm

14. Intermediate Tracheal Tube -- Excellent for oral and nasal intubations where a shorter cuff is desired -- Features: Murphy tip and eye Tip-To-Tip radiopaque line Pilot balloon and mechanical self-sealing valve

15. Tracheal Tube -- Meets the guidelines of the cuff criteria. -- Thin cuff conforms to uneven tracheal surfaces to create low pressure seal. -- Large cuff diameter of 1- 1/2 times the average trachea maintains proper low-pressure seal

16. COLE TRACHEAL TUBE -- Patient end smaller than rest of tube -- Sized according to the ID of the tracheal portion -- Widened portion should not contact larynx -- Cannot be used nasally as the wide segment will not pass through nares

17. Evac Endotracheal Tube with Evacuation Lumen -- Convenient and safe method for suctioning accumulated secretions in the subglottic space -- Low VAP incidence -- Useful for a-gas sampling b- airway pressure monitoring c- giving drugs and d- jet ventilation

18. Jet Tracheal Tube -- Features: Magill curve Uncuffed -- Includes: Main Lumen for ventilation Insufflation lumen permits the delivery of jet ventilation

19. Endobronchial double lumen tube

20. With CPAP System -- Improves oxygenation during one-lung anesthesia. -- Anesthesia bag to aid opening alveoli -- Adjustable valve supplies pressures in clinical settings from 1 to 10cm H20

21. Oral Ring Adair Elwin tracheal Tube -- Preformed curve removes circuit from surgical field. -- Unique design assures patent airway while reducing risk of kinks and disconnects. -- Rectangular mark at preformed curve aids correct positioning.

22. Nasal RAE Tracheal Tube

23. Indications -- Nasal surgery & Facial surgery -- Ophthalmic surgery -- Prone positioning

24. Laser – Flex Tracheal Tube -- Stainless steel body is airtight, flexible and laser- resistant. -- Reflected beams from the tube are defocused to reduce accidental laser strikes to healthy tissue. -- Smooth surface and Magill curve minimize trauma during intubation.

25. Combitu b e

26. Features -- For difficult or emergency intubation. -- Blind placement without laryngoscope. -- Unique design provides patent airway with either esophogeal or tracheal placement. -- Reduces risk of aspiration of gastric contents.

27. Lo-Contour Tracheal Tube -- Cuff lies close to the tube while deflated for better view of vocal cords -- Translucent white tube is easy to see in trachea -- Adequate cuff diameter provides low-pressure seal.

28. ET Tube with Controllable Tip -- Loop controls the direction of the tip -- Radius of curvature is reduced by pulling the loop -- Useful in blind intubation s

29. Reinforced Tracheal Tube -- Soft, flexible PVC tube with spiral-wound reinforcing wire -- Reduced risk of kinking. -- Reinforcing wire is sealed tightly against bonded connector.

30. Tube with Lanz Pressure Regulating Valve - Reduces risk of tracheal damage during long-term intubations. - Lanz valve reduces the need for manual cuff pressure monitoring.

31. Microlaryngeal Tracheal Tube -- Small cuff size & I.D. and O.D. provide greater access -- ID of 4, 5 or 6 mm only -- Cuff diameter: that of 8 mm tube -- Used when airway has been narrowed by a tumor or other abnormality.

32. P reforme d L a r y nge c tomy Tube

33. Uncuffed Tracheal Tube -- Wide range of pediatric sizes -- Provides better fit even for premature infants. -- Distal tip reference lines and depth marks -- Thin, but strong tube wall provides maximum inner diameter for proper ventilation.

34. Uncuffed Tracheal Tube with Monitoring Lumen

35. T racheosto m y Tubes

36. J Shaped Tracheostomy Tubes -- Available in larger sizes for patients with a tracheostomy -- The short portion of the J is inserted into the trachea, and the long portion lies flat against the chest -- Reduces risk of accidental disconnection/extubation

37. S umma r y -- Oropharyngeal airways -- Nasopharyngeal airways -- Endotracheal Tubes -- Tracheostomy tubes

38. T HANK YOU