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Tracheal Intubation Under Vision

Tracheal Intubation Under Vision. Orlando Hung Departments of Anesthesia, Surgery, and Pharmacology, Dalhousie University, Halifax, Nova Scotia. Objectives. Review of the laryngoscopes and videolaryngoscopes Main characteristics of these devices Limitations of these devices.

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Tracheal Intubation Under Vision

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  1. Tracheal Intubation Under Vision Orlando Hung Departments of Anesthesia, Surgery, and Pharmacology, Dalhousie University, Halifax, Nova Scotia

  2. Objectives • Review of the laryngoscopes and videolaryngoscopes • Main characteristics of these devices • Limitations of these devices

  3. Principles of Airway Management

  4. Miller Laryngoscope (Straight Blade)

  5. Alternatives to direct laryngoscopies

  6. Video-Laryngoscopes

  7. Video-Laryngoscopes • 2 basic types • channelled • Non-channelled

  8. Channelled Videolaryngoscopes • Pentax Pentax AirwayScope AirTraq King Vision Videolaryngoscope

  9. Non-Channelled Videolaryngoscopes

  10. Glidescope

  11. Main Characteristics of Glidescope • The distal half of the blade angled upward approximately 60

  12. Glidescope

  13. Main Characteristics of Glidescope • The distal half of the blade angled upward approximately 60 • The image is displayed on a monitor with a rechargeable battery

  14. Main Characteristics of Glidescope • The distal half of the blade angled upward approximately 60 • The image is displayed on a monitor with a rechargeable battery • Video images can be stored • Anti-fogging technology that automatically warms the glass covering the video chip preventing condensation

  15. Disadvantages of the Glidescope • Cleaning takes time and that means a long down time • Expensive • High profile and may be difficult to use in patients with a small mouth opening or fixed flexion of the neck • May be challenging in the presence of copious amount of blood and secretions. • The need for a degree of eye-hand coordination • Less portable (needs cables and monitor)monitor)

  16. Glidescope Cobalt

  17. Glidescope Ranger

  18. Storz CMAC

  19. Main Characteristics of CMAC • Macintosh laryngoscope blade with different sizes • The image is displayed on an LCD monitor • Still images and video images can be recorded • The glottic view can be achieved either under direct laryngoscopy (DL) or under indirect laryngoscopy (video display). • A D-Blade (Difficult airway blade) is now available.

  20. Differences Between CMAC and Glidescope • Direct laryngoscopy • No stylet is needed if intubation under direct vision • More useful in the presence of blood and copious secretions

  21. Disadvantages of the CMAC • Cleaning takes time and that means a long down time • Expensive • High profile and may be difficult to use in patients with a small mouth opening or fixed flexion of the neck • Potential fogging • Less portable (needs cables and monitor)

  22. McGrath Series 5 Video-Laryngoscope

  23. Main Characteristics of McGrath Series 5 Videolaryngoscope • An LCD screen is mounted atop the handle of the laryngoscope to display the image • An adjustable CameraStick • Powered by a single 1.5V AA battery • A single-use, low-profile, polycarbonate blade cover can be placed over the CameraStick

  24. Main Advantages of McGrath Series 5 Videolaryngoscope • Portability • low-profile • ease of setup • lack of wires and cables • excellent glottic views • Disposable blade allows a rapid turn-around • The blade and handle can be disarticulated if needed

  25. Disadvantages of the McGrath Series 5 Video-laryngoscope • Expensive • Small screen • Potential fogging • May be challenging in the presence of copious amount of blood and secretions. • The need for a degree of eye-hand coordination

  26. McGrath Macintosh Videolaryngoscope

  27. Technique of Intubation Using a Videolaryngoscope • Visualization • Tube delivery • Tube advancement

  28. Visualization

  29. Visualization • Midline insertion in general (except the CMAC)

  30. Visualization • Midline insertion in general • If the epiglottis is obscuring laryngeal exposure, it can be elevated directly by the tip of the Glidescope blade.

  31. Tube Delivery • Watch the tube entry into the oropharyx • The tube should enter from the corner of the mouth • Use of a stylet and tracheal introducer

  32. Trac

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