Tracheal Intubation Under Vision

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

5. Miller Laryngoscope (Straight Blade)

10. Alternatives to direct laryngoscopies

11. Video-Laryngoscopes

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

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

16. Non-Channelled Videolaryngoscopes

17. Glidescope

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

19. Glidescope

20. 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

22. 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

25. 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)

26. Glidescope Cobalt

28. Glidescope Ranger

29. Storz CMAC

30. 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.

32. 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

35. 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)

37. McGrath Series 5 Video-Laryngoscope

38. 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

40. 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

41. 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

42. McGrath Macintosh Videolaryngoscope

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

44. Visualization

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

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

48. 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

49. Trac