Anesthesia Instruments and Tools

Anesthesia Instruments and Tools

By Dr. Saleha Jabali, 2022

Standard Instruments for Airway Management Under GA

Anesthesia Face Mask

Advantages:

• Facilitates GA inhalational induction and maintenance without airway instrumentation and irritation.
• Adequately seals the mouth and nose to allow positive pressure ventilation.
• Available in variable sizes and disposable.

Disadvantages:

• Hands are not free.
• High positive pressure may cause gastric distention and risk of aspiration.

Oropharyngeal Airway

Advantages:

• Variable sizes.
• Disposable.
• Adjunct to face mask and displaces the tongue to open the airway.

Disadvantages:

• Highly irritant to the airway; if the patient has a gag reflex, it may cause vomiting and airway obstruction.

Nasopharyngeal Airway

Advantages:

• Can be used in conscious and semiconscious patients.
• Variable sizes.
• Disposable.

Disadvantages:

• Risk of nasal trauma and epistaxis.

Classic or Direct Laryngoscopy

• Macintosh (curved)
• Miller (straight)

Supraglottic Devices

• Laryngeal mask

Advantages:

• Does not require advanced training.
• Variable sizes.
• Allows positive pressure ventilation (max 25 cm H2O pressure).
• Emergency tool in difficult ventilation and intubation.

Disadvantages:

• Easily displaced, causing laryngospasm and airway obstruction.
• Does not protect from aspiration.
• High ventilation pressure can lead to stomach insufflation.
• Not ideal for long surgical procedures or surgeries in the airway.

Infraglottic Airway Devices

• Endotracheal tube

Advantages:

• Secure the airway.
• Allows positive pressure ventilation with no risk of gastric insufflation.
• Provides better protection from aspiration than supraglottic devices.
• Used for long surgical and airway procedures.
• Allows suction of the airway.

Disadvantages:

• Requires high skill level for training.
• Risk of endobronchial intubation and lung collapse.
• Risk of vocal cord injury.

Sizes:

• Pediatric: 1-8 years old is age/4 + 4 (age divided by 4 + 4).
  • e.g., 4-year-old boy needs ETT = 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 the 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.

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