A new device to facilitate blind tracheal intubation

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A new device to facilitate blind tracheal
intubation

• Joe Wai, P. Tjong
• Association of Anaesthetists of Great Britain
  Ireland  
• January 2003  p 8889
• ????????
• 920429

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Device structure

• two J-shaped pieces
• one metal (an open structure, consisting mainly
  of 5 mm steel)
• one plastic (preformed to allow a tracheal tube
  to slide in it).

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How to intubate
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Advantage

• Can use in difficult laryngoscopic intubation.
• Patient with limited mouth opening or restricted
  neck extension.
• No pivotal stress on the front teeth.
• Palpation of the throat confirms the position of
  the device at the vocal cords without the need to
  see them.

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Study result

• Study of 20 patients.
• 19 patients at the first attempt.
• Postoperative sequelae 3 patients sore throat
  and 1 hoarse voice for an evening, which
  disappeared the following day.
• Further clinical trials are planned to confirm
  the clinical value of this device and its place
  in the difficult airway situation.

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Retrograde intubation with a Mini-Trach II kit

• P. Slots, P. B. Vegger and H. Bettger and P.
  Reinstrup
• Acta Anaesthesiologica Scandinavica Volume
  47 Issue 3 Page 274  - March 2003

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Background

• Retrograde intubation has been accepted
  internationally as a viable alternative for
  managing the difficult airway. Various techniques
  have been described to perform this procedure,
  however, difficulties have arisen on account of
  problems with suboptimal materials. We therefore
  describe a retrograde intubation technique using
  the knife and stiff plastic introducer from a
  Mini-Trach II set from Portex Ltd (Kent, UK).

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Methods

• The cricothyroid membrane was identified and
  using the knife from the mini-trach set, incised
  longitudinally. The plastic introducer was
  inserted through the incision and maneuvered out
  through the mouth providing a guide over which
  the endotracheal tube was threaded. The technique
  was evaluated on 20 cadavers and thereafter used
  in four patients.

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Results

•  Mean intubation time in the 20 cadavers was
  6.7 s (range 3-10) from incision to removal of
  the guide. Also, the technique was used
  successfully in four patients in whom anterograde
  attempts failed. In one of these patients the
  retrograde intubation was life saving

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Conclusion

•  Retrograde intubation with a stiff curved
  plastic introducer was rapid and easy in cadavers
  and in four patients. In emergency situations
  where conventional intubation fails it may be
  life saving

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The intubating laryngeal-mask airway may be an
ideal device for airway control in the rural
trauma patient

• Young B.
• Am J Emerg Med 2003 Jan21(1)80-5

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• A review of the literature on advanced airway
  management indicates that the intubating
  laryngeal-mask airway (ILMA) may be an ideal
  device for airway control in the rural trauma
  patient.
• The ILMA is an advanced laryngeal-mask airway
  designed to allow oxygenation of the unconscious
  patient as well as blind tracheal intubation with
  an endotracheal tube.
• The ILMA is an easy-to-use airway with a high
  success rate of insertion, and requires little
  training.

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• For the rural physician managing a difficult
  airway in a trauma patient, the ILMA has been
  found to be reliable and successful when other
  techniques fail, such as fiberoptic intubation
  and direct laryngoscopy.
• The ILMA has also been reported to cause less
  hemodynamic change and less injury to the teeth
  and lips than direct laryngoscopy.
• ILMA was found to be easier and faster to use
  with a higher success rate than either the
  combitube or endotracheal tube for unskilled
  healthcare providers.
• Limitations and complications of the ILMA may
  include aspiration, esophageal intubation, damage
  to the larynx or other tissues during blind
  passage of a tracheal tube, and edema of the
  epiglottis.