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Magnetic and articulating (MNA) Bougie assisted breathing tube placement during intubation

Group Members: Chris Cloney Laura Hadley brian joseph Ian Westhaver Supervisor: Dr. Ted Hubbard Clients: dr. Andrew Milne 1,2 , dr. Dennis Drapeau 1 1 Department of anesthesia – Dalhousie university 2 School of Biomedical Engineering – Dalhousie University.

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Magnetic and articulating (MNA) Bougie assisted breathing tube placement during intubation

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  1. Group Members: Chris Cloney Laura Hadley brian joseph Ian Westhaver Supervisor: Dr. Ted Hubbard Clients: dr. Andrew Milne1,2, dr. Dennis Drapeau1 1 Department of anesthesia – Dalhousie university 2 School of Biomedical Engineering – Dalhousie University Magnetic and articulating (MNA) Bougieassisted breathing tube placement during intubation Group #7 Dalhousie University Senior Design Project

  2. Overview • Introduction • Requirements • Methodology • Testing and Initial Design • Final Design • Results • Future Plans • Adapted from Fong 2004 [1]

  3. Introduction to Standard Intubation • Current Devices • Breathing tube • Laryngoscope • Technique • Achieve visualization • Insert breathing tube • 15-17,000 intubations per year (QEII – anesthesia department )

  4. Design Problem • Difficult Intubation: 2-3% of all intubations (300 – 500 per year) • Design and construct a device to use with a video laryngoscope to insert a breathing tube in difficult intubation scenarios. Introducing Bougie

  5. Design Requirements

  6. Design Methodology • Mechanical devices • Difficult to use • Magnets • Intuitive • Allows for fine motion

  7. Testing – Distance Minimum distance required for attraction Minimum attraction distance between small magnet and large ceramic magnet. It was determined that a magnet with the strength of at least 6 ceramic magnets should be used. X Error bars at 95% confidence (3 trials)

  8. Testing – Forces Minimum separation force X Error bars at 95% confidence (5 trials) Force required to pull magnets off of a steel beam. This standard test case is used to size commercial magnets for purchase.

  9. Key Features • Bougie • Magnetic tip attracted into trachea • Flexible tip to encourage articulation • In conjunction with video laryngoscope • External magnet • Attracts magnetic bougie tip • Varying force • Controlled by anesthesiologist or anesthesiologist's assistant

  10. Initial Design • External magnet • Cumbersome • Imprecise control • Bougie • Tip not rigid enough • Tip connection is too delicate MAGNET MAGNET

  11. Final Design • Two Components • External magnet • Interior bougie • External magnet moves flexible bougie tip

  12. Final Design – Bougie Magnetic Tip Balloon Connection

  13. Final Design – Bougie • Balloon • Inflated by syringe • Coarse articulation 50 mm

  14. Final Design – Bougie • Connection • Joins flexible end to stiffer bougie shaft • Flexible material allows for greater tip articulation

  15. Final Design – Bougie • Tip • Magnet encased by flexible tip • Fine articulation

  16. Final Design – Magnet

  17. Final Design – Magnet • Shell • Can be disassembled for cleaning

  18. Final Design – Magnet • Magnet • 1-1/2” dia. x 1/4” thick • 50 N

  19. Final Design Implementation • Magnetic Tip (Yellow) • Flexible Tip (White) • Balloon (Orange) • Trachea (Green) • Esophagus (Red) • Lung (Pink)

  20. Safety • Sterilization • Disposable bougie • Casing easily disassembled • No detachable parts • Forces • Cricoid pressure • (30–40 N) [3] • Less than 10 N Error bars at 95% confidence (3 trials)

  21. Results

  22. Future Plans • Construction of first iteration of final design by Jan 31st • Testing completed through month of February • Usability of external design • Forces directly on vocal cords • Possible cadaver testing • Iteration of design and final construction

  23. Questions? • Acknowledgments • We would like to thank our clients Dr. Andrew Milne and Dr. Dennis Drapeau for their time and insight on this project. • We would also like to thank our supervisor Ted Hubbard for the direction and intuition provided for this project. References [1] Sally Fong. 2004. Intubation. Retrieved from http://www.aic.cuhk.edu.hk/web8/Intubation.htm [2] Rassam, S., Wilkes, A., Hall, J., Mecklenburgh. 2005. A comparison of 20 laryngoscope blades using intubating manikin: visual analogue scores and forces exerted during laryngoscopy. Anaesthesia60:384-394 [3] Vanner, R. 1992. Tolerance of cricoidepresure by conscious volunteers. International Journal of Obstetric Anesthesia. 1:4:195-198

  24. Medium Testing

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