Anesthesia Instrument and Tools
by Dr Saleha Jabali 2022
Standard Instrument for Airway Management Under GA
- Anesthesia face mask
Advantage
- Facilitate GA inhalational induction and maintenance without airway instrumentation and irritation
- Adequately sealing the mouth and nose to allow positive pressure ventilation
- Variable sizes and disposable
Disadvantage
- Hands are not free
- High positive pressure may cause gastric distention and risk of aspiration
Mask Sizes
- Adult - Large
- Adult - Medium
- Adult - Small
- Pediatric
- Neonatal
- Infant
Oropharyngeal Airway
Advantage
- Variable sizes
- Disposable
- Adjunct to face mask and displace the tongue and open the airway
Disadvantage
- Highly irritant to the airway if patient gag reflex is present it will cause vomiting and airway obstruction
Color Coding for Airways
- Blue - GA 20
- Black - GA 10
- White - GA 01
- Green - GA 02
- Yellow - GA 03
- Red - GA 04
Nasopharyngeal Airway
Advantage
- Can be used in conscious and semiconscious patient
- Variable sizes
- Disposable
Disadvantage
- Nasal trauma and epistaxis
Laryngoscopy Types
- Classic or direct laryngoscopy
- Macintosh (curved)
- Miller (straight)
Supraglottic Devices
- Laryngeal mask
Advantage
- Does not need advance training
- Variable sizes
- Allow positive pressure ventilation (max 25 cmH2O pressure)
- Emergency tool in difficult ventilation and intubation
Disadvantage
- Easily displaced causing laryngospasm and airway obstruction
- Does not protect from aspiration
- High ventilation pressure leads to stomach insufflation
- Not ideal for long surgical procedures or surgery in the airway
Infraglottic Airway Devices
- Endotracheal tube
Advantage
- Secure the airway
- Allow Positive pressure ventilation with no risk of gastric insufflation
- Protect from aspiration better than supraglottic devices
- Used for long surgical and airway procedures
- Allow suction of the airway
Disadvantage
- Need high skill of training
- Endobronchial intubation and lung collapse
- Risk of vocal cord injury
Sizesz
-
Pediatric 1-8 years old is age/4+4 (age divided by 4 + 4)
-
e.g. 4 y old boy needs ETT is 4/4+4= 1+4= 5 ID
-
Depth by equal chest movement
-
Age/2 +12 = depth from lip
-
e.g. 4 year old boy tube will be fixed at: 4/2+12= 2+12 = 14 cm fixation at lip
-
Adult
- Female 7 ID and fix at 19 cm
- Male 7.5-8 ID fix at 21 cm
Bag Valve Mask
Anesthesia Breathing Circuit
The breathing circuit is the critical connection between the anesthesia machine and the patient - Through which anesthesiologist can give positive pressure ventilation.
Difficult Airway Management Tools
- Fiberoptic: rigid, flexible
- Video Laryngoscopy
- Lightwand
- Bougie
- Transtracheal jet
- Single-use Flexible Scope
Intubating Stylet (Bougie)
Advanced Video Assisted Airway Devices
Glidescope with Disposable Blade
- GVL® Stat
- Reusable Video Baton
