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Multilumen Airways
•Inserted blindly•Proven to secure airway and allow for
better ventilation.•Two devices:
▫Pharyngotracheal lumen airway ▫Combitube
Multilumen Airways
•Combitube ▫Long tube▫Can be used
for ventilation whether it is inserted into the esophagus or trachea
Multilumen Airways• Indications
▫ Unresponsive, apneic patients with no gag reflex in whom intubation is not possible Cannot be used in
children younger than 16 years
Only use for patients between 5 ft and 7 ft tall.
• Contraindications▫ Esophageal trauma▫ Known pathologic
condition of the esophagus
▫ Ingestion of a caustic substance
Multilumen Airways
• Advantages▫ Ventilation in
esophagus or trachea ▫ Insertion is easier
than ET intubation▫ Minimal cervical spine
movement▫ No mask seal ▫ Airway patency
• Disadvantages▫ Wrong port results in
no pulmonary ventilation
▫ Risk of aspiration▫ Intubating the trachea
via direct laryngoscopy is challenging.
Complications of Multilumen Airways
•Unrecognized displacement into esophagus
•Laryngospasm, vomiting, hypoventilation •Pharyngeal or esophageal trauma •Ventilation may be difficult if the
pharyngeal balloon pushes the epiglottis over the glottic opening.
Insertion Techniques •Combitube
consists of:▫Single tube with
two lumens▫Two balloons▫Two ventilation
attachments•Before insertion,
prepare equipment.
Insertion Techniques
•Head should be in a neutral position▫Insert thumb into the mouth and lift the
jaw.•Insert device until incisors are between
the two black lines•Two valves must be inflated sequentially.
Insertion Techniques
•After inflation of balloons, begin to ventilate▫Through the longer (blue) tube first
•Observe for chest rise and auscultate.▫If there are no breath sounds, switch to the
shorter (clear) tube.•Continuously monitor ventilation.
Laryngeal Mask Airway (LMA)•Option for patients who:
▫Require more support than bag-mask ▫Do not require ET intubation
•Conduit from glottic opening to ventilation device
Laryngeal Mask Airway (LMA)•Surrounds
larynx opening with an inflatable cuff ▫Cuff conforms
to airway contours, forms airtight seal
Laryngeal Mask Airway (LMA)
•Indications and contraindications ▫Alternative to bag-mask ventilation▫Less effective in obese patients▫Pregnant patients and patients with a hiatal
hernia are at risk for regurgitation.▫Ineffective with patients requiring high
pulmonary pressures
Laryngeal Mask Airway (LMA)• Advantages
▫ Better ventilation ▫ No continual
maintenance of a mask seal
▫ No laryngoscopy▫ Less risk of trauma ▫ Protection from
secretions
• Disadvantages▫ No protection against
aspiration▫ Air may be insufflated
into the stomach
Complications of Using LMA
•Involve regurgitation and aspiration ▫Weigh against risk of hypoventilation
•Hypoventilation of patients who require high ventilatory pressures can occur.
•Upper airway swelling has been reported.
Equipment for LMA
•Seven sizes; based on the patient weight•Consists of tube and inflatable mask cuff•Two bars at opening prevent occlusion•Proximal end is fitted with standard
adapter
Equipment for LMA•Cuff has a one-
way valve assembly
•6.0-mm ET tube can be passed through size 3 or 4 LMA
King LT Airway•Latex-free, single-
use, single-lumen▫Positive-pressure
ventilation for apneic patients
▫Maintains airway in spontaneously breathing patients who need advanced management
.
King LT Airway
•Curved tube with ventilation ports between two inflatable cuffs▫Can be inserted
more easily than the Combitube
King LT Airway
•Two types:▫King LT-D: used
for adults and children
▫King LTS-D: used for adults Five sizes of each
type
King LT Airway
•King LT-D and LTS-D share many features:▫Proximal pharyngeal cuff, distal cuff,
ventilation outlets ▫ET tube introducer can be inserted through
the tube▫Distal end: closed in LT-D; open in LTS-D
King LT Airway
• Indications▫ Alternative to bag-
mask ventilation ▫ Same considerations
as Combitube
• Contraindications▫ Patients with an intact
gag reflex▫ Patients with known
esophageal disease▫ Patients who have
ingested a caustic substance
Complications of the King LT Airway
•Laryngospasm, vomiting, hypoventilation•Trauma from improper insertion
technique•Pharyngeal balloon may push the
epiglottis over the glottic opening ▫May make ventilation difficult
Cobra Perilaryngeal Airway (CobraPLA)
•Shape lets device: ▫Slide easily along
the hard palate▫Hold airway’s soft
tissue away from the laryngeal inlet
•Available in eight sizes
Cobra Perilaryngeal Airway (CobraPLA)
• Indications▫ Usage similar to other
supraglottic airway devices
▫ Can be used in pediatric patients
▫ Does not protect against aspiration
• Contraindications▫ Risk for aspiration▫ Risk for massive
trauma to oral cavity