Laryngeal Mask Airway & Tracheostomy Tubes Lecture (6) PDF

ANAESTHESIA & ANAESTHESIA EQUIPMENT Laryngeal mask airway & Tracheostomy tubes Lecture (6) ALNOOR UNIVERSITY PORTFOLIO College of Health and Medical Techniques Olivia Wilson DR.Radwan AL -Bakri Abdul Aziz Riyadh Rania...

ANAESTHESIA & ANAESTHESIA EQUIPMENT Laryngeal mask airway & Tracheostomy tubes Lecture (6) ALNOOR UNIVERSITY PORTFOLIO College of Health and Medical Techniques Olivia Wilson DR.Radwan AL -Bakri Abdul Aziz Riyadh Rania Nameer Abdullah Yahya 1 Laryngeal mask airway 2 3 This very useful device is frequently used as 4 an alternative to either the face mask or 5 tracheal tube during anaesthesia. Low-cost, 6 7 disposable or reusable laryngeal masks have 8 been introduced and are widely used. 9 10 11  Components 1. It has a transparent tube of wide ID. The proximal end is a standard 15-mm connection. 1 2. An elliptical cuff is found at the distal end. The cuff resembles a small face mask to form an air- tight seal around the posterior perimeter of the larynx 2 3. pilot balloon with a self- sealing valve. 4. The original design had two slits or bars at the junction between the tube and the cuff to 3 prevent the epiglottis from obstructing the lumen of the laryngeal mask 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11  Indications for the use of the LMA 1. improve oxygenation as part of rapid sequence airway approach 1 2. patient who cannot be intubated 2 3. elective anesthesia cases 3 4. cardiac arrest 4 Contraindications of the LMA 5 1. Increased risk of aspiration (Prolonged bag-valve-mask ventilation, morbid 6 7 obesity, second or third trimester pregnancy) 8 2. Suspected or known abnormalities in supraglottic anatomy 9 3. Consciousness or presence of a gag reflex 10 4. Complete upper airway obstruction 11 5. Cannot open mouth  INSERTION TECHNIQUE 1 1. Select the appropriately sized LMA 2. Inflate and deflate the cuff to check its volume and ensure there are no leaks. 2 3. With the cuff completely deflated, apply a small amount of sterile, water-soluble 3 lubricant to the posterior surface of cuff 4 4. Pre-oxygenate the patient 5. Flex the patient’s neck, lift the chin( sniffing position) 5 6. Insert the LMA into the mouth, pushing with the index or long finger in the v- 6 shaped notch where the tube attaches to the mask. 7. Inflate the cuff. 7 8. Connect a bag-valve apparatus to the tube. 8 9. Begin ventilation (8 to 10 breaths/minute, each about 500 mL and lasting about 1 9 second). 10 10. Assess lung ventilation by auscultation and chest rise. 11 11. Check end-tidal carbon dioxide to confirm placement. 12. Fix the tube in place as appropriate. 1 2 3 4 5 6 7 8 9 10 11  Tracheostomy & Tracheostomy tracheal tubes 1 Tracheostomy: is a surgical procedure that 2 3 creates an opening in the anterior wall of the 4 trachea to facilitate airway access and 5 ventilation 6 Tracheostomy tracheal tubes: 7 These are curved plastic tubes usually inserted 8 9 through the second, third and fourth tracheal 10 cartilage rings. 11  Components 1. The proximal end can have a standard 15-mm connector. 2. An introducer is used for insertion. 1 3. Wings (flange) are attached to the proximal part of the tube to fix it in place 4. They can be cuffed or uncuffed. 2 5. pilot balloon , Inflation line ( cuffed) 3 6. The tip is usually cut square, rather than bevelled. This decreases the risk of obstruction 4 5 6 7 8 9 10 11  Indications for tracheostomy 1. To facilitate weaning from a ventilator. This is due to a reduction in the sedation 1 required, as the patients tolerate tracheostomy tubes better than tracheal tubes. Also, 2 there is a reduction in the anatomical dead space 3 4 2. Maintenance of an airway and to protect the lungs in patients with impaired 5 pharyngeal or laryngeal reflexes and after major head and neck surgery (e.g. 6 laryngectomy). 7 3. Long-term control of excessive bronchial secretions especially in patients with a 8 reduced level of consciousness. 9 4. Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm 10 5. Long-term mechanical ventilation. 11 6. Upper airway obstruction.  Complications of tracheostomy 1. tracheoesophageal fistula 1 2. Bleeding ( hemorrhage) 2 3. vocal cord dysfunction 3 4. subglottic stenosis 4 5. pneumothorax 5 6. Infection 6 7. scarring. 7 8 Contraindications for tracheostomy 9 1. Abnormal airway anatomy 2. Enlarged thyroid 10 3. Coagulopathy 11 1 2 Thank you 3 4 5 6 7 8 9 10 11