Rotigs

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Rotigs

• Brad NaPier MD
• Hanu Surgical Devices

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Rapid Oral Tracheal Intubation Guidance System

• Facilitates Direct Fiberoptic Minimally Invasive
  Transoral...
• Bronchoscopic Intubation, Laryngoscopy,
  Esophagoscopy, Bronchoscopy

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Developed For

• The less frequent endoscopist
• Anesthesiologists, CRNAs, ER physicians, ICU
  physicians/pulmonologists, ENTs

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Rotigs
Mouthpiece
Bite Block
Guidance Tube
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Transoral Bronchoscopic Intubation

• under utilized approach because oral
  airway/intubators rest on the tongue, cause
  gagging, do not stay in the midline, do not allow
  tongue to be retracted anteriorly
• often requires sedation with associated
  pharyngeal collapse

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Opinion

• Many anesthesiologists are not confident in
  transoral bronchoscopic intubation with the
  currently available oral airway/intubators
• Anesthesiologists will accept a simple, safe,
  Rotigs assisted approach to intubation.

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History of Oral Airways

• Guedel Oral Airway 1933
• Berman Oral Aiway 1950
• Berman Intubating Oral Airway 1977
• Williams Airway Intubator 1979
• Ovassapian Fiberoptic Intubating Airway 1991

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Evolution of Oral Airway/Intubators

• Guedel (1933) and Berman (1950) developed oral
  airways
• During the 70s fiberoptic scopes became popular.
  Intubating channels were added to the oral
  airways to become oral airway/intubators.
• Rotigs is an oral intubator not an oral
  airway/intubator

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Williams, Berman,Ovassapian

• rest on tongue, poorly tolerated, initiate gag
  reflex
• do not stay in midline and increase difficulty
  approaching vocal cords
• do not allow anterior movement of tongue to
  facilitate visualization of the glottis

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Belief

• By directing a midline bronchoscopic pathway,
  eliminating the gag reflex, and allowing
  manipulation of the tongue, Rotigs improves the
  success of bronchoscopic intubation or transoral
  endoscopy

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Belief

• Most infrequent endoscopists prefer a transoral
  endoscopic approach versus a transnasal approach
  with the associated risk of epistaxis

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Novel Aspects

• Bilateral bimolar stabilization keeps the device
  in the midline and allows a midline endoscopic
  approach
• Does not rest and tongue and cause gag reflex
• Allows anterior movement of tongue to facilitate
  visualization of the glottis

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Novel Aspects

• Eliminates the risk of nasal intubation and
  epistaxis
• Allows a slightly larger ET tube (8)
• Topical anesthesia, no pharyngeal collapse
• Intubator, not an oral airway
• Protects endoscope from biting

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Topical Anesthesia

• 2 Xylocaine and 1/4 nasal and oral spray
• Nebulization of 3 ccs of 4 Xylocaine
• Many other good topical techniques

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Previous Devices

• cause gagging and often require sedation with
  associated pharyngeal collapse and turn a
  difficult airway into a critical airway
• Rotigs does not require sedation, eliminates
  pharyngeal collapse, and allows a safe approach
  to transoral intubation

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Rotigs Summary

• Potentially facilitates safe, awake, transoral
  endoscopy and intubation
• Applications include bronchoscopic intubation,
  laryngoscopy, bronchoscopy, and esophagoscopy
• Favorably shifts learning curve of novice
  endoscopists

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Rotigs Summary

• Facilitates diagnostic laryngoscopy for ER
  physicians
• Cost effective for an HMO
• Generates income for a Fee for Service ER
• May allow rapid Dx for pharyngeal airway and
  increases quality of care
• Eliminate false of lateral soft tissue XRAY

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Rotigs Summary

• May increase direct fiberoptic laryngoscope and
  intubating brochoscope use and sales
• May allow increased success of bronchoscopic
  intubation
• Does no harm in awake transoral intubation
• Increases number of potential endoscopists

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Rotigs Summary

• Indications may include Obese Airway and
  Difficult Airway
• May favorably shift the learning curve of novice
  GI endoscopists
• May be candidate for difficult airway cart

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Animation

• an animation of Rotigs can be viewed at
  www.hbeclient.info/rtg/

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Meaning of Hanu

• Hanu is Hawaiian for the giver of breath

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Rotigs versus Glide

• Rotigs for non sedated intubation
• Glide scope for sedated intubation

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Rotigs

• A transoral appliance that facilitates
  bronchoscopic intubation, laryngoscopy,
  bronchoscopy, and esophagoscopy.