A new airway device for small laboratory animals
|
|
- Piers Preston
- 5 years ago
- Views:
Transcription
1 A new airway device for small laboratory animals A. Imai 1*, P. H. Eisele 2 & E. P. Steffey 1 1 Department of Surgical & Radiological Sciences, and 2 Center for Laboratory Animal Science, School of Veterinary Medicine, University of California, Davis, CA 95616, USA Summary There is a need for a device for improved management of the airway of small laboratory animals during general anaesthesia. This report introduces such a device, referred to here as the airway device (AD). The AD has some similarity to the laryngeal mask airway (LMA) developed for human patients, but the mask portion of the device is specifically designed for small laboratory animals. In addition, the device has an oesophageal extension and unlike the LMA does not have a cuff associated with the mask. This report also shares experience of tests of one prototype AD with six New Zealand white rabbits. The AD was used for administering isoflurane and its effectiveness was evaluated during conditions of spontaneous and controlled intermittent positive pressure ventilation. The results provide encouragement for further development of the AD for airway management of small laboratory animals. Keywords Rabbit; airway management; laryngeal mask; rabbit anaesthesia Airway obstruction and the resultant inadequate ventilation and oxygenation occur frequently in unconscious animals. Accordingly, careful airway management is an essential part of safe anaesthetic practice regardless of the species. In unconscious human patients, airway management is usually accomplished by inserting a tube into the trachea (i.e. tracheal intubation), but at times a face mask or laryngeal mask airway (LMA) is used (Brain 1983). While similar techniques are applied to animal patients and subjects involved in biomedical investigations, problems of size diminish their use in very small animals such as rabbits and rats. For example, the technique of applying a mask to the surface of the nose *Present address: B32-32, Hiwa-machi Kanazawa, Ishikawa , Japan Correspondence to: E. P. Steffey epsteffey@ucdavis.edu and mouth, while facilitating oxygen delivery, may not provide a patent airway because secretions or the tongue and other structures inside the oropharynx or nasopharynx may still serve to obstruct the airway. An endotracheal tube (ETT), on the other hand, most commonly facilitates a patent airway and permits effective positive pressure ventilation. However, performing endotracheal intubation in small laboratory animals is difficult and often traumatic to the animal because of their small size. In addition, an unacceptable limit to the size of airway orifice may occur. The LMA is a relatively new device developed especially for human patients. It consists of a tube that opens into an elliptical mask with an inflatable rim that is designed to provide and maintain a seal around the laryngeal inlet. The LMA is available in sizes to fit humans from neonates to large adults. The seal around the laryngeal opening permits Accepted 1 June 2004 Laboratory Animals Ltd.,
2 112 Imai, Eisele & Steffey spontaneous or mechanical ventilation with gas of controlled composition. This device provides more direct connection to the trachea than does a face mask, and is less invasive than the ETT technique. Unfortunately, presently available LMA sizes are not suitable for small laboratory animals and the inflatable cuffed mask itself may obstruct the airway if used in this group of animals. To resolve some of these difficulties and in turn extend our ability to reliably secure a patent airway during general anaesthesia particularly in small laboratory animals, we constructed a prototype of an airway device (AD) suitable for these species. This report summarizes the results of this development and our experiences of initial testing with anaesthetized rabbits. Materials and methods The airway device Anatomical definitions of the oral cavity, pharynx, larynx, trachea, and oesophagus were moulded from post-mortem rabbits, ferrets, rats, and mice and assessed for device design. A prototype was constructed according to the design shown in Fig 1. The prototype was composed of three parts (connected in series) a tube, a mask and a balloon. The device is constructed of pliable silicone. The tube portion contains a continuous spiral wire within its wall to better insure patency of the tube lumen. The balloon portion is designed to lie in the Fig 1 Prototype of an airway device for small laboratory animals proximal oesophagus. The mask surrounds and seals the larynx. The tube serves as a conduit for respiratory gases to and from the trachea. A prototype AD was evaluated in anaesthetized New Zealand white rabbits. The size of the mask for the adult rabbit used was cm and the length of the tube was 12 cm. The external diameter of the tube was 6.5 mm and its internal diameter, 5 mm. The balloon part was 3 cm in length. A polyethylene tube (ID 1 mm) was housed inside this particular prototype for inspired and expired gas sampling. The end of the gas sampling tube was opened at the base of the mask part. Animals, anaesthesia protocol, and data analyses Animals Six adult female New Zealand white rabbits were used. Mean body weight ( SD) of the rabbits was kg. Rabbits were obtained from a commercial supplier (Charles River Laboratories, Wilmington, MA, USA). All of them were specific pathogen free. They were housed in the AAALAC-accredited facilities at the Center for Laboratory Animal Science at the University of California, Davis. Each rabbit was housed in a wire cage (size: cm) in a temperature ( C) and light-controlled building. Rabbits were fed a commercial pelleted diet (Rabbit Chow Purina Mills, LLC, St Louis, MO, USA) and water ad libitum. Animal care and use were approved by the Campus Animal Use and Care Administrative Advisory Committee of the University of California, Davis. Anaesthesia All anaesthetics were performed during daylight hours of 08:00 h to 17:00 h. Unmedicated rabbits, not fasted for food or water, were weighed and placed in an acrylic chamber. Oxygen was provided to the chamber at a flowrate of 4 l/min for 5 min before anaesthetic induction. Anaesthesia was then induced by delivering 5% isoflurane in 4 l/min oxygen to the chamber. Following recumbency, the rabbit was taken from the box and anaesthesia was
3 A new airway device 113 deepened using a face mask connected to a Bain circuit with similar conditions of fresh gas delivery. After establishing an adequate depth of anaesthesia by checking the usual clinical signs for the rabbit (Imai et al. 1999), the AD was positioned. Device insertion was performed with the rabbit positioned in lateral recumbency and with its neck flexed ventrally. The balloon part of the device was then inflated with air (e.g ml) and the tube part of the device was connected to a Bain circuit. Anaesthesia was maintained with isoflurane in oxygen (2 l/min) provided via the device. The rabbits breathed spontaneously. Respiratory rate (f ), inspired and end-tidal isoflurane concentrations (I Iso and ET Iso), inspired and endtidal carbon dioxide (I CO 2 and ET CO 2 ), and inspired and end-tidal oxygen concentration (I O 2 and ET O 2 ) were monitored by a calibrated anaesthesia monitoring apparatus (Datex Capnomac Ultima, Datex Medical Instrumentation Inc., Tewksbury, MA, USA) via the gas sampling tube and were recorded. Pulse oximetry technology was used to monitor pulse rate and arterial oxygen saturation (O 2 Sat a ) throughout the anaesthesia. The pulse oximeter probe was positioned on the shaved base of the tail. Rectal temperature of the animal was frequently checked by thermister and maintained normothermic as necessary by externally applied heat. The influence of changing anaesthetic concentration was monitored during spontaneous ventilation. Mechanical ventilation was performed during periods of anaesthesia by connecting the breathing circuit to a Bird ventilator. Intermittent positive pressure ventilation (IPPV) was initially performed at a peak airway pressure (P aw ) of 10 cmh 2 O with a respiratory frequency of per min. Then the P aw was increased to 12 cmh 2 O and 15 cmh 2 O. The circumference of the abdomen of the rabbit was measured before and after IPPV to provide insight to changes in gastrointestinal gas volume that might accompany IPPV. After IPPV and return of spontaneous ventilation, the AD was removed and the status of the oral cavity and airway was quickly evaluated under direct visualization using a laryngoscope. A 3.0 mm ID cuffed ETT (Hudson RCI, Sheridan/CF Hudson Respiratory Care, Inc., Temecula, CA, USA) was then inserted and the anaesthetized rabbit was evaluated during spontaneous ventilation and IPPV conditions similar to those during the preceding use of the AD. Following these observations, the ETT was removed and the AD reintroduced and the ET Iso re-stabilized at 3.1% for 5 min. The I Iso concentration was then abruptly reduced to zero and conditions associated with awakening and AD removal were evaluated. Data analyses All the numerical data were grouped and are reported as mean SD. The ET Iso, I Iso, ET CO 2, I CO 2, ET O 2, I O 2 and f at the end of ET Iso conditions of 2.1%, 2.5%, and 3.1% during spontaneous and mechanical ventilation were statistically analysed by use of repeated measures ANOVA followed by use of the Tukey test when indicated. The results from the uses of the AD and ETT were compared by the Bonferonni test when indicated by results of repeated measures ANOVA. Significance was set at the 5% level. Results Intubation status Anaesthetic depth sufficient to insert the AD was judged adequate when the rabbit s eye was positioned centrally and jaw tone was relaxed enough to pass the tube into the mouth. During these conditions, the device was inserted blindly in one to three attempts without difficulty. Some attempts were not successful on the first try because either the anaesthesia depth was too light or the head positioning of the animal was inappropriate. The correct positioning of the device was checked by a variety of techniques such as ausculting for airflow noise in the throat using a stethoscope, and observing altered capnographic wave forms. When the mask part of the device was rotated to facilitate known airway leakage characteristics of leakage included: airflow sounds in the throat, detection of isoflurane
4 114 Imai, Eisele & Steffey at the nose, and alterations in the normal shape of the capnograph. Performance of AD and ETT Conditions of general anaesthesia were unremarkable regardless of the mode of airway maintenance. The f (breaths/min) and ET CO 2 (mmhg) at ET Iso 2.1%, 2.5% and 3.1% with AD were and 35 4, 47 6 and 39 5, and and 36 5, respectively. The f and ET CO 2 with ETT at the same dose of ET Iso were 42 3 and 38 2, 42 6 and 39 4, and 44 6 and 39 5, respectively, and did not differ from results with the AD. Positive pressure ventilation was accomplished with AD and ETT in all rabbits without obvious gas leakage. Mild localized redness (n 2) and mild swelling (n 1) in the pharyngeal region were seen after IPPV with the AD. The circumference of the abdomen before and after IPPV with the AD did not change. Recovery from anaesthesia was calm and uneventful in all rabbits. All rabbits lifted their head at the time of extubation. Three of the rabbits moved their mouth and tongue before extubation. No rabbits chewed the tube before or at the time of extubation. Averaged ET Iso recorded just before extubation was % (range: %). Discussion Securing the airway is essential to maintain adequate ventilation when an animal is anaesthetized. However orotracheal intubation is difficult and often traumatic in small species and as a result of the small size of the tube used may actually confound breathing mechanics. The AD described in this report was designed to offer advantages of tracheal intubation without some of the disadvantages specific to small laboratory animals. The AD has some similarities to the LAM used in human patients and in some animals. The commercially available sizes of LMA have been applied successfully to spontaneously breathing cats (Fujita et al. 1991, Asai et al. 1998), dogs (Braz et al. 1999), pigs (Patil et al. 1997), and ferrets (Brietzke & Mair 2001), and IPPV was successfully performed with this technique in cats, pigs, and ferrets. However, in some of these trials, gastric content aspiration and gastric distention occurred. The AD we developed has important differences from the LAM. These include: (a) smaller size, (b) the absence of an inflatable cuff surrounding the mask (this allows for a greater airway lumen, which is an advantage with such a small tube), and (c) the presence of a balloon projection intended to be positioned in the oesophagus for stabilization, to minimize the likelihood for air passage to the stomach, and to prevent regurgitation of lower oesophageal and stomach contents. These features enable the AD to provide improved airway management in small animal species. The work described was intended to be preliminary since only one species of small laboratory animal is represented and the number of rabbits used was small (n 6). Accordingly, firm conclusions are not proposed or are possible. Nonetheless, present results encourage further development. The device was easily inserted blindly in an adequately anaesthetized rabbit, and was well tolerated without clinicallysignificant complications. The device has many attributes. A patent airway was easily and simply attained, and was successfully maintained during both spontaneous and mechanically-controlled ventilation. Usually the airway was established on the first attempt, with no more than three attempts being necessary for successful insertion of the AD. Presumably with practice, adequate anaesthetic depth, and proper positioning of the animal, the number of insertion attempts can be minimized. Conversely, even with trained personnel, endotracheal intubation of rabbits is usually challenging, with multiple attempts often being necessary. The number of attempts before successful tracheal intubation and the amount of associated trauma often increase with decreasing animal size. The device offers many advantages of endotracheal intubation and seemingly
5 A new airway device 115 improves on this technique. It provides direct access to the trachea for controlled delivery and removal of inhaled anaesthetics while also providing for a larger airway diameter and, in turn, potentially improves breathing mechanics. Further, in the very small animal species, its ease of insertion without need for a laryngoscope or similar device, reduces complications associated with the need to visualize and force open the vocal cords, and penetrate the laryngeal opening with an ETT. Conversely, some negative features are undeniably present. Airway obstruction with a portion of the AD may occur when the tube is incorrectly positioned or dislocated. Application of a properly sized AD with proper placement and fixation are essential. Compared to the ETT, this AD, like the LMA, is less desirable for the animal who is at risk of regurgitation and/or active vomiting of gastric contents, or has blood or foreign matter in the upper airway. Likewise, despite our favourable results in the present limited studies, the AD may not produce an airtight seal around the larynx, especially under conditions of high inspiratory pressures during IPPV. However, we used pressures of up to 15 cmh 2 O without notable air leaks or measurable distension of the gastrointestinal tract and abdomen. The complete absence of local trauma cannot be avoided, although with careful use this complication should be trivial and should be more than balanced by the opportunities afforded. The mild redness and local tissue swelling that was seen in the pharyngeal region of three rabbits after IPPV were most likely caused by local friction between the mask portion of the AD and the pharyngeal tissue. The tube material (silicone) and local motion of the AD during IPPV may have also contributed to the incidence of the localized signs. Despite these minor observations, further consideration in this regard is warranted. Nonetheless, these features should be considered in the light of individualized needs and relative to other techniques available. References Asai T, Murano K, Katoh T, Shingu K (1998) Use of the laryngeal mask airway in laboratory cats. Anesthesiology 88, Brain AIJ (1983) The laryngeal mask. A new concept in airway management. British Journal of Anaesthesia 55, Braz JRC, Martins RHG, Mori AR, Luna SPL (1999) Investigation into the use of the laryngeal mask airway in pentobarbital anesthetized dogs. Veterinary Surgery 28, Brietzke SE, Mair EA (2001) Laryngeal mask versus endotracheal tube in a ferret mode. Annals of Otology, Rhinology and Laryngology 110, Fujita M, Orima H, Shimizu M, Motoyoshi A, Katayama M, Miyasaka K (1991) Use of laryngeal mask airway in small animals. Journal of Veterinary Medical Sciences 53, Imai A, Steffey EP, Ilkiw JE, Farver TB (1999) Comparison of clinical signs and hemodynamic variables used to monitor rabbits during halothaneand isoflurane-induced anesthesia. American Journal of Veterinary Research 60, Patil VU, Fairbrother CR, Dunham BM (1997) Use of the laryngeal mask airway for emergency or elective airway management situations in pigs. Contemporary Topics 36, 47 9
Other methods for maintaining the airway (not definitive airway as still unprotected):
Page 56 Where anaesthetic skills and drugs are available, endotracheal intubation is the preferred method of securing a definitive airway. This technique comprises: rapid sequence induction of anaesthesia
More informationAIRWAY MANAGEMENT AND VENTILATION
AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management D2 Basic
More informationUse of laryngeal mask airway compared to endotracheal tube with positive-pressure ventilation in anesthetized swine
Veterinary Anaesthesia and Analgesia, 2007, 34, 284 288 doi:10.1111/j.1467-2995.2006.00329.x RESEARCH PAPER Use of laryngeal mask airway compared to endotracheal tube with positive-pressure ventilation
More informationThis interdisciplinary clinical support document provides guidelines for the safe establishment of an artificial airway.
PURPOSE This interdisciplinary clinical support document provides guidelines for the safe establishment of an artificial airway. POLICY STATEMENTS Endotracheal intubation will be performed by the Most
More informationI. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device
I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device II. Policy: Continuous Positive Airway Pressure CPAP by the Down's system will be instituted by Respiratory Therapy personnel
More informationWaitin In The Wings. Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider
Waitin In The Wings Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider 1 CombiTube Kit General Description The CombiTube is A double-lumen tube with
More informationAnatomy and Physiology. The airways can be divided in to parts namely: The upper airway. The lower airway.
Airway management Anatomy and Physiology The airways can be divided in to parts namely: The upper airway. The lower airway. Non-instrumental airway management Head Tilt and Chin Lift Jaw Thrust Advanced
More informationSESSION 3 OXYGEN THERAPY
SESSION 3 OXYGEN THERAPY Harith Eranga Yapa Department of Nursing Faculty of Health Sciences The Open University of Sri Lanka 1 Outline Methods of delivery Complications of oxygen therapy Artificial airways
More informationAdvanced Airway Management. University of Colorado Medical School Rural Track
Advanced Airway Management University of Colorado Medical School Rural Track Advanced Airway Management Basic Airway Management Airway Suctioning Oxygen Delivery Methods Laryngeal Mask Airway ET Intubation
More informationRecent Advances in Airway Management HA Convention 2014
Recent Advances in Airway Management HA Convention 2014 Dr. HK Cheng Chief of Service (Dept. of Anaesthesia & OT) Service Director (Ambulatory Surgery Centre) Tseung Kwan O Hospital Recent Advances in
More informationComparison between facemask and laryngeal mask airway in rabbits during isoflurane anesthesia
Veterinary Anaesthesia and Analgesia, 2005, 32, 280 288 RESEARCH PAPER Comparison between facemask and laryngeal mask airway in rabbits during isoflurane anesthesia Leigh Bateman* BVSc, MRCVS, John W Ludders*
More informationEquipment: NRP algorithm, MRSOPA table, medication chart, SpO 2 table Warm
NRP Skills Stations Performance Skills Station OR Integrated Skills Station STATION: Assisting with and insertion of endotracheal tube (ETT) Equipment: NRP algorithm, MRSOPA table, medication chart, SpO
More informationGeneral Medical Procedure. Emergency Airway Techniques (General Airway Protocol)
General Medical Procedure Appropriate airway management is often the most important intervention a prehospital care provider makes, as ensuring adequate oxygenation and ventilation is crucial to the survival
More informationPedi-Cap CO 2 detector
Pedi-Cap CO 2 detector Presentation redeveloped for this program by Rosemarie Boland from an original presentation by Johnston, Adams & Stewart, (2006) Background Clinical methods of endotracheal tube
More informationComparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.
Title Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients Author(s) Greenland, KB; Ha, ID; Irwin, MG Citation Anaesthesia,
More informationUse of the Intubating Laryngeal Mask Airway
340 Anesthesiology 2000; 93:340 5 2000 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Use of the Intubating Laryngeal Mask Airway Are Muscle Relaxants Necessary? Janet
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur
More informationVentilating the paediatric patient. Lizzie Barrett Nurse Educator November 2016
Ventilating the paediatric patient Lizzie Barrett Nurse Educator November 2016 Acknowledgements Kate Leutert NE PICU Children's Hospital Westmead Dr. Chloe Tetlow VMO Anaesthetist and Careflight Overview
More informationDIFFICULT AIRWAY MANAGMENT. Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr)
DIFFICULT AIRWAY MANAGMENT Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr) AIRWAY MANAGEMENT AND MAINTAINING OXYGENATION ARE THE FUNDAMENTAL RESPONSIBILITIES OF ANY BASIC DOCTOR. TO MANAGE A DIFFICULT AIRWAY,
More informationADVANCED AIRWAY MANAGEMENT
The Advanced Airway Management protocol should be used on all patients requiring advanced airway management procedures. This protocol is divided into three sections the Crash Airway Algorithm, the Rapid
More informationAirway Anatomy. Soft palate. Hard palate. Nasopharynx. Tongue. Oropharynx. Hypopharynx. Thyroid cartilage
Airway Anatomy Hard palate Soft palate Tongue Nasopharynx Oropharynx Hypopharynx Thyroid cartilage Airway Anatomy Hyoid bone Thyroid cartilage Cricoid cartilage Trachea Cricothyroid membrane Airway Anatomy
More informationstudent handbook BARS handbook September 2012.indd Front Cover 27/11/12 12:08 PM
student handbook BARS handbook September 2012.indd Front Cover 27/11/12 12:08 PM All materials regarding the Basic Airway Resuscitation Strategy Course were written and developed by Dr. Richard Morris
More informationAngkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital
AIRWAY MANAGEMENT Angkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital Perhaps the most important responsibility of the anesthesiologist is management of the patient s airway Miller
More informationISPUB.COM. The Use of LMA in Newborn Resuscitation. R Vadhera INTRODUCTION VENTILATION
ISPUB.COM The Internet Journal of Anesthesiology Volume 1 Number 4 The Use of LMA in Newborn Resuscitation R Vadhera Citation R Vadhera. The Use of LMA in Newborn Resuscitation. The Internet Journal of
More informationAirway Management Essentials Self-Study Guide
Airway Management Essentials Self-Study Guide Fourth Quarter 2010 Self-Study Guide Learning Objectives Cognitive Domain 1. Describe the various conditions that cause concern during treatment in the field
More informationOverview. Chapter 37. Advanced Airway Techniques. Sellick Maneuver 9/11/2012
Chapter 37 Advanced Airway Techniques Slide 1 Sellick Maneuver Purpose Anatomic Location Technique Special Considerations Overview Advanced Airway Management of Adults Esophageal Tracheal Combitubes Tracheal
More informationSupra-glottic Airway Devices
Supra-glottic Airway Devices Dr.K.Sudarshan Consultant Anaesthesiologist Coimbatore The ability to maintain an airway is one of the core skills and defining role of an anaesthetist. It is needless to say
More informationCONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation
More information1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to
1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only. In
More informationAirway Management. DFMRT Casualty Care Examination Course. Revision notes for. January Les Gordon
Airway Management Revision notes for DFMRT Casualty Care Examination Course January 2013 Les Gordon Indicating special information in Revision Notes presentations New information since Casualty Care in
More informationThe LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients
British Journal of Anaesthesia 96 (3): 396 400 (2006) doi:10.1093/bja/ael001 Advance Access publication January 16, 2006 The LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under
More informationAirway Workshop Lecture. University of Ottawa
Airway Workshop Lecture Department of Anesthesiology University of Ottawa Overview Ventilation Airway assessment Difficult airways Airway management equipment aids Intubation/Improving Intubation Success
More informationChapter 40 Advanced Airway Management
1 2 3 4 5 Chapter 40 Advanced Airway Management Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only.
More informationIntroducing the Fastrach-LMA. Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council
Introducing the Fastrach-LMA Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council Objectives Review Anatomy of the Upper Airway Review LFEMSC LMA Protocol Discuss Indications
More informationCuffed Tracheal Tubes in Children - Myths and Facts. PD Dr. Markus Weiss Department of Anaesthesia University Children s Hospital Zurich Switzerland
Cuffed Tracheal Tubes in Children - Myths and Department of Anaesthesia University Children s Hospital Zurich Switzerland PRO Reduced gas leak, low fresh gas flow Decreased atmospheric pollution Constant
More informationAdvanced Airway Management
CHAPTER 37 Advanced Airway Management Airway Anatomy and Physiology Review Respiratory System: The Airway Respiratory System (Supine) Physiology: Factors of Adequate Breathing Functioning brainstem Open
More informationREVERSE LMA INSERTION IN A NEONATE WITH KLIPPEL-FEIL SYNDROME
REVERSE LMA INSERTION IN A NEONATE WITH KLIPPEL-FEIL SYNDROME - Case report - TARIQ AL ZAHRANI * Klippel-Feil syndrome (KFS) was first described by Maurice Klippel and Andre Feil in 1912 in a patient with
More information2007 Recertification Session. Airway review
2007 Recertification Session Airway review Level of awareness: This is similar to the AVPU, the GCS is performed later Verbal, loud verbal, or pain stimulus. If pain stimulus, consider a trapezeus squeeze
More informationSmall Volume Nebulizer Treatment (Hand-Held)
Small Volume Aerosol Treatment Page 1 of 6 Purpose Policy Physician's Order Small Volume Nebulizer Treatment To standardize the delivery of inhalation aerosol drug therapy via small volume (hand-held)
More informationUse of the Aintree Intubation Catheter with the Laryngeal Mask Airway and a Fiberoptic Bronchoscope in a Patient with an Unexpected Difficult Airway
Case Report Use of the Aintree Intubation Catheter with the Laryngeal Mask Airway and a Fiberoptic Bronchoscope in a Patient with an Unexpected Difficult Airway Andrew Zura MD, D. John Doyle MD PhD FRCPC,
More informationBasic Airway Management
Basic Airway Management Dr. Madhurita Singh, Assoc. Professor, Dept. of Critical Care, CMC Vellore. This is the first module in a series on management of airway and ventilation in critically ill patients.
More informationOrotracheal Intubation
T h e n e w e ng l a nd j o u r na l o f m e dic i n e videos in clinical medicine Orotracheal Intubation Christopher Kabrhel, M.D., Todd W. Thomsen, M.D., Gary S. Setnik, M.D., and Ron M. Walls, M.D.
More informationPet owners are often very anxious about veterinary procedures that involve anesthesia. This handout attempts to alleviate some of these concerns.
Printable Version Anesthesia for Cats Pet owners are often very anxious about veterinary procedures that involve anesthesia. This handout attempts to alleviate some of these concerns. The word anesthesia
More informationI - Gel Versus Cuffed Tracheal Tube in Elective Laparoscopic Cholecystectomy A Clinical Comparative Study
Original Research I - Gel Versus Cuffed Tracheal Tube in Elective Laparoscopic Cholecystectomy A Clinical Comparative Study Siddharam Jamagond 1, Anuradha H 2, Ramesh.K 3 1 Senior resident, Department
More informationAirway and Ventilation. Emergency Medical Response
Airway and Ventilation Lesson 14: Airway and Ventilation You Are the Emergency Medical Responder Your medical emergency response team has been called to the fitness center by building security on a report
More informationComparison of Ease of Insertion and Hemodynamic Response to Lma with Propofol and Thiopentone.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 12 Ver. IV (Dec. 2015), PP 22-30 www.iosrjournals.org Comparison of Ease of Insertion and Hemodynamic
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur rapidly
More informationBirds are hard to keep alive...
Birds are hard to keep alive... Advances in Drugs Monitoring Understanding of birds Anaesthesia provides.. Immobilisation Analgesia Muscle relaxation Oxygen Reduced stress? Better control... Intubation
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid, assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur
More informationThe Laryngeal Mask and Other Supraglottic Airways: Application to Clinical Airway Management
The Laryngeal Mask and Other Supraglottic Airways: Application to Clinical Airway Management D. John Doyle MD PhD FRCPC Department of General Anesthesiology Cleveland Clinic Foundation 9500 Euclid Avenue
More informationCuffed or uncuffed ETT in pediatric anesthesia? Dr. Renata Haghedooren Dr. Sophie Chullikal Dr. Julie Lauweryns
Cuffed or uncuffed ETT in pediatric anesthesia? Dr. Renata Haghedooren Dr. Sophie Chullikal Dr. Julie Lauweryns Overview History Survey Tradition Pro-Con Debate Conclusions History of intubation 1878:
More informationRespiratory Guard System: New Technology
Respiratory Guard System: New Technology Zvi Peled, Avishai Zisser, Michal Fertouk, Victor Kerzman, Keren Bitton-Worms and Gil Bolotin. Department of Cardiac Surgery, Rambam Health Care Campus, Technion
More informationPhysiological normal values (Depends on age, strain, health status, type of anesthesia, etc.)
UBC Animal Care Guidelines This SOP will be used for: Inhalational anesthesia SOP: ACC-01-2017 Rodent Anesthesia Injectable anesthesia Submitted by: Shelly McErlane both inhalational and injectable anesthesia
More informationCitation British journal of anaesthesia, 104. pp ; 2010 is available onlin
NAOSITE: Nagasaki University's Ac Title Laryngeal mask airway Supreme for a Author(s) Murata, Hiroaki; Nagaishi, Chikako; Citation British journal of anaesthesia, 104 Issue Date 2010-03 URL Right http://hdl.handle.net/10069/24856
More informationLMA Supreme Second Seal. Maintain the airway. Manage gastric contents. Meet NAP4 recommendations.
LMA Supreme Second Seal Maintain the airway. Manage gastric contents. Meet NAP4 recommendations. A proven double seal The importance of the Second Seal (oesophageal seal) is significant: it can minimise
More informationChapter 10 The Respiratory System
Chapter 10 The Respiratory System Biology 2201 Why do we breathe? Cells carry out the reactions of cellular respiration in order to produce ATP. ATP is used by the cells for energy. All organisms need
More informationSubspecialty Rotation: Anesthesia
Subspecialty Rotation: Anesthesia Faculty: John Heaton, M.D. GOAL: Maintenance of Airway Patency and Oxygenation. Recognize and manage upper airway obstruction and desaturation. Recognize and manage upper
More informationInterfacility Protocol Protocol Title:
Interfacility Protocol Protocol Title: Mechanical Ventilator Monitoring & Management Original Adoption Date: 05/2009 Past Protocol Updates 05/2009, 12/2013 Date of Most Recent Update: March 23, 2015 Medical
More informationGENERAL ANAESTHESIA AND FAILED INTUBATION
GENERAL ANAESTHESIA AND FAILED INTUBATION INTRODUCTION The majority of caesarean sections in the UK are performed under regional anaesthesia. However, there are situations where general anaesthesia (GA)
More informationUnanticipated difficult tracheal intubation - during routine induction of anaesthesia in an adult patient
Unanticipated difficult tracheal intubation - during routine induction of anaesthesia in an adult patient Direct laryngoscopy Any problems Call for help Plan A: Initial tracheal intubation plan Direct
More informationDon t let your patients turn blue! Isn t it about time you used etco 2?
Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P
More informationISPUB.COM. The Video-Intubating Laryngoscope. M Weiss THE LARYNGOSCOPE INTRODUCTION TECHNICAL DESCRIPTION
ISPUB.COM The Internet Journal of Anesthesiology Volume 3 Number 1 M Weiss Citation M Weiss.. The Internet Journal of Anesthesiology. 1998 Volume 3 Number 1. Abstract A Macintosh intubating laryngoscope
More informationAll bedside percutaneously placed tracheostomies
Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy
More informationWeaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim
Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration
More informationWe will not be using the King LTS-D in our system!
King LT-D The King LT is a superior, disposable supraglottic airway tool that utilizes the latest technological advances in materials and design to provide the best nonintubating airway possible. The King
More informationISSN X (Print) Research Article. *Corresponding author Dr. Souvik Saha
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(6B):2238-2243 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationCAE Healthcare Human Patient Simulator (HPS)
CAE Healthcare Human Patient Simulator (HPS) The Human Patient Simulator, HPS, is a tethered simulator that is capable of patient assessment and treatment including mechanical ventilation and anesthesia.
More informationGeneral OR Rotations GOALS & OBJECTIVES
General OR Rotations GOALS & OBJECTIVES Goals At the end of the CA 1 year General OR rotations, the resident should competently manage uncomplicated ambulatory, orthopedic, maxillo-facial, ENT, gynecologic,
More informationA CRITICALLY ILL CHILD PRESENTING AT AN ACUTE TRUST- A CLINICAL AND ETHICAL CHALLENGE
A CRITICALLY ILL CHILD PRESENTING AT AN ACUTE TRUST- A CLINICAL AND ETHICAL CHALLENGE DR SRIKANTH UPPUGONDURI CONSULTANT ANAESTHESTIST NEW CROSS HOSPITAL CALL FROM PAEDIATRIC TEAM CALL FROM PAEDIATRIC
More informationINTUBATION/RSI. PURPOSE: A. To facilitate secure, definitive control of the airway by endotracheal intubation in an expeditious and safe manner
Manual: LifeLine Patient Care Protocols Section: Adult/Pediatrics Protocol #: AP1-009 Approval Date: 03/01/2018 Effective Date: 03/05/2018 Revision Due Date: 12/01/2018 INTUBATION/RSI PURPOSE: A. To facilitate
More informationComparison of efficacy of the Laryngeal tube with the Laryngeal mask airway in securing the upper airway
Original Research Article Comparison of efficacy of the Laryngeal tube with the Laryngeal mask airway in securing the upper airway Khaja Ali Hassan 1,*, Ahsan Mustafa 2 1,2 Assistant Professor, Department
More informationDr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia
DIFFICULT AIRWAY CANNOT VENTILATE, CANNOT INTUBATE. Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia Difficult airway According to AMERICAN SOCIETY OF ANAESTHESIOLOGISTS Difficult Airway is defined
More informationOverview. The Respiratory System. Chapter 18. Respiratory Emergencies 9/11/2012
Chapter 18 Respiratory Emergencies Slide 1 Overview Respiratory System Review Anatomy Physiology Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination Emergency
More informationCHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS
CHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS PRACTICAL STATIONS CHANHASSEN FIRE DEPARTMENT MEDICAL / RESCUE SKILLS 1. CARDIAC ARREST MANAGEMENT 2. AIRWAY & RESPIRATORY MANAGEMENT 3. SPINAL IMMOBILIZATION
More informationTracheostomy and laryngectomy airway emergencies: an overview for medical and nursing staff
2013 Medical Journal Tracheostomy and laryngectomy airway emergencies: an overview for medical and nursing staff Steven Lobaz 1 and Paul Bush 2 1 ST6 and 2 Consultant Department of Anaesthesia and Intensive
More informationA randomised comparison between Cobra PLA and classic laryngeal mask airway and laryngeal tube during mechanical ventilation for general anaesthesia
ORIGINAL AND CLINICAL PAPERS Anaesthesiology Intensive Therapy 2013, vol. 45, no 1, 20 24 ISSN 1642 5758 DOI: 10.5603/AIT.2013.0004 www.ait.viamedica.pl A randomised comparison between Cobra PLA and classic
More informationOriginal Contributions
Standard Laryngeal Mask Airway and LMA-ProSeal during Laparoscopic Surgery Giuseppe Natalini, MD,* Gabriella Lanza, MD,* Antonio Rosano, MD,* Piera Dell Agnolo, MD,* Achille Bernardini, MD Department of
More informationINDEPENDENT LUNG VENTILATION
INDEPENDENT LUNG VENTILATION Giuseppe A. Marraro, MD Director Anaesthesia and Intensive Care Department Paediatric Intensive Care Unit Fatebenefratelli and Ophthalmiatric Hospital Milan, Italy gmarraro@picu.it
More informationENDOTRACHEAL INTUBATION POLICY
POLICY Indications: Ineffective ventilation with mask and t-piece, or mask and bag technique Inability to maintain a patent airway Need or anticipation of need for prolonged ventilation Need for endotracheal
More informationAirway Management and The Difficult Airway
Airway Management and The Difficult Airway Gary McCalla, MD, FACEP Medical Director REACH Air Medical Services Services 1 It is not enough to do your best, unless you have prepared to be the best. -John
More informationLEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS. - Our Perspective.
ISSN: 2250-0359 Volume 3 Issue 4 2013 LEVITAN S FIBREOPTIC STYLET: BEYOND BARRIERS - Our Perspective. Justin Ebenezer Sargunaraj * Dr.Balasubramaniam Thiagarajan * *Stanley Medical College ABSTRACT: This
More informationNicolette Mosinski MPAS, PA-C
Nicolette Mosinski MPAS, PA-C 1. Impaired respiratory effort 2. Airway obstruction Observe patient for detection Rate Pattern Depth Accessory muscle use Evidence of injury Noises Silent manifestations
More informationAirway Management From Brady s First Responder (8th Edition) 82 Questions
Airway Management From Brady s First Responder (8th Edition) 82 Questions 1. What color will cyanotic skin be? p. 119 *A.) Blue B.) Red C.) Yellow D.) Green 2. Which is the primary path for air to enter
More informationCompetency Title: Continuous Positive Airway Pressure
Competency Title: Continuous Positive Airway Pressure Trainee Name: ------------------------------------------------------------- Title: ---------------------------------------------------------------
More informationAIRWAY MANAGEMENT SUZANNE BROWN, CRNA
AIRWAY MANAGEMENT SUZANNE BROWN, CRNA OBJECTIVE OF LECTURE Non Anesthesia Sedation Providers Review for CRNA s Informal Questions encouraged 2 AIRWAY MANAGEMENT AWARENESS BASICS OF ANATOMY EQUIPMENT 3
More informationCONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS
Brit. J. Anaesth. (1954), 26, 111. CONCENTRATIONS OF DIETHYL ETHER IN THE BLOOD OF INTUBATED AND NON-INTUBATED PATIENTS BY A. MACKENZIE, E. A. PASK AND J. G. ROBSON Medical School, King's College, and
More information(ix) Difficult & Failed Intubation Queen Charlotte s Hospital
(ix) Difficult & Failed Intubation Queen Charlotte s Hospital Pre-operative Assessment Clinical assessment of airway and risk of difficult intubation: (can be performed in a matter of seconds): 1. Mouth
More informationUnconscious exchange of air between lungs and the external environment Breathing
Respiration Unconscious exchange of air between lungs and the external environment Breathing Two types External Exchange of carbon dioxide and oxygen between the environment and the organism Internal Exchange
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationPORTO 2 VENT CPAP OS. Operator s Manual. PORTO 2VENT CPAP OS System Operator s Manual Part Number Rev I
PORTO 2 VENT CPAP OS Operator s Manual 1 2 TABLE of CONTENTS 1. Introduction 3. Operating Instructions 1a. Definitions 3a. Setting the CPAP Level 1b. General Description 3b. Applying the Breathing Circuit
More informationRisky Extubation. Andy Higgs. Warrington Hospitals Cheshire UK
Andy Higgs Warrington Hospitals Cheshire UK Declaration COOKMEDICAL Extubation plan DAS guideline Airway Exchange Catheters # 11 CAEC post maxillo-facial surgery Used as intubation stylets Airway Exchange
More informationUpper Airway Obstruction
Upper Airway Obstruction Adriaan Pentz Division of Otorhinolaryngology University of Stellenbosch and Tygerberg Hospital Stridor/Stertor Auditory manifestations of disordered respiratory function ie noisy
More informationRandomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients
Anaesth Intensive Care 2010; 38: Randomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients E. F. F. CHEW*, N. HANEEM, C. Y. WANG Department of Anaesthesia,
More informationCricoid pressure: useful or dangerous?
Cricoid pressure: useful or dangerous? Francis VEYCKEMANS Cliniques Universitaires Saint Luc Bruxelles (2009) Controversial issue - Can J Anaesth 1997 JR Brimacombe - Pediatr Anesth 2002 JG Brock-Utne
More informationBrachycephalic Airway Syndrome (Upper Airway Problems Seen in Short-Nosed Breeds) Basics
Brachycephalic Airway Syndrome (Upper Airway Problems Seen in Short-Nosed Breeds) Basics OVERVIEW Partial upper airway obstruction in short-nosed, flat-faced (brachycephalic) breeds of dogs and cats caused
More informationCAPNOGRAPHY DR JOHN ROOS
CAPNOGRAPHY DR JOHN ROOS Abraham Lincoln If you want me to speak for an hour give me a moment s notice if you want me to speak for five minutes give me a week. Missed oesophageal intubation Many studies
More informationThe Laryngeal Tube. An Evaluation of the Laryngeal Tube During General Anesthesia Using Mechanical Ventilation
An Evaluation of the Laryngeal Tube During General Anesthesia Using Mechanical Ventilation Luis A. Gaitini, MD*, Sonia J. Vaida, MD*, Mostafa Somri, MD*, Victor Kaplan, MD*, Boris Yanovski, MD*, Robert
More informationPharmacology: Inhalation Anesthetics
Pharmacology: Inhalation Anesthetics This is an edited and abridged version of: Pharmacology: Inhalation Anesthetics by Jch Ko, DVM, MS, DACVA Oklahoma State University - Veterinary Medicine, February
More informationAnesthesia Final Exam
Anesthesia Final Exam 1) For a patient who is chronically taking the following medications, which two should be withheld on the day of surgery? a) Lasix b) Metoprolol c) Glucophage d) Theodur 2) A 51 year
More information