AIRWAYS,

LARYNGOSCOPES, NRVS
AND CONNECTORS (I)
A P
 DESCRIPTION
 Name
 Specific– Water’s airway
 General – Oropharyngeal airway

 Material

 Parts

 Specific modification

 Use

 Sterilization/ Disposable
POSSIBLE COURSE OF VIVA
 Choose any one – Laryngoscope, DLT

 Name of the designer, other

innovations

 Applications

 Advantages

 Disadvantages

 Comparison - two laryngoscope blades

Airway Anatomy
 The purpose of an airway is
to lift the tongue and
epiglottis away from the
posterior pharyngeal wall
and prevent them from
obstructing the space
above the larynx. Using
maneuvers such as
dorsiflexion at the atlanto-
occipital joint and
protrusion of the mandible
anteriorly may still be
necessary to ensure a
patent airway .
 An oral or nasal airway
decreases the work of
breathing during
spontaneous breathing
using a face mask.
 Types

 Oropharyngeal airways

 Nasopharyngeal airways

 Modified (a) Laryngeal mask airway

(b) Cuffed oropharygeal
airway
 An oropharyngeal airway
 Elastomeric material or plastic
 The flange at the buccal end to
prevent it from moving deeper into
the mouth. The flange may also
serve as a means to fix the airway
in place.
 The bite portion is straight and
fits between the teeth or gums. It
must be firm enough that the
patient cannot close the lumen by
biting but sloghtly compressible.
Wide enough to make contact wit 2
or more teeth.
 The curved portion extends
backward to correspond to the
shape of the tongue and palate.
Proper size

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 AIRWAYS
 Connell’s – Holes in
lateral walls
 Water’s - nipple for
Oxygenation
 Both are metallic –
Brass and chrome
 More traumatic

 Difficult to clean,
autoclavable
 The Guedel airway
 Guedel’s oropharyngeal
airway
 Plastic with reinforced bite
portion
 Colour coded in six sizes

 has a large flange, a

reinforced bite portion, and a
tubular channel.
 Oval in cross section

 Patent airway channel

 Disposable
 The Berman airway
 Center support and open
sides.
 H shaped in cross section

 Flat – better as bite block

 Flange at the buccal end.

 The side opening can be

opened wider to engage or
disengage a tracheal tube.
 Modification
 Hinged tip
 Intubating airway
Insertion – Oropharyngeal airways

 Rule out limiting

factors
 Check size

 Check patency

 Lubricate

 Position

 Direction
 Modifications
 Resuscitation
 Safar’s
 Brook’s
 Intubation Aids
 Berman intubation
pharyngeal airways
 Patil-Syracuse Endoscopic
Airway
 Williams Airway Intubator
 Ovassapian Fiberoptic
Intubating Airway
SAFARS AIRWAY (SIZES – ADULT AND
PAEDIATRIC)

 In 1958, Safar and McMahon

 S-shaped oropharangeal airway

 Two Guedel’s airways soldered together

 Non traumatic soft rubber

 Use – Mainly for artificial resuscitation

BROOK AIRWAY
 Artificial respiration could
be performed without
direct mouth-to-mouth or
mouth to- nose contact
 Mouth guard flap to fit
snugly over the patient’s
lips
 Flexible rubber neck
 Leading to a straight
plastic tube containing a
built-in spring one-way
valve
 Aids for intubation
Berman intubation airways Ovassapian airway
Ovassapian Airway

Patil Syracuse Airway William’s Airway

Intubator
 The Berman intubating/pharyngeal
airway
 Tubular along its entire
length
 It is open on one side
so that it can be split
and removed from
around a tracheal tube
 Oral airway or as an
aid to fiberoptic or
blind orotracheal
intubation
 Better than manual
tongue retraction
 OVASSAPIAN FIBREOPTIC
INTUBATING AIRWAY
 Fibreoptic intubation
 Description- It has a flat, narrow lingual surface
on the proximal end, which gradually widens at
the distal end. At the buccal end are 2 vertical
side walls. There are 2 pairs of curved guide walls
between the side walls. The guide walls curve
towards each other, leaving a space between
them for a tracheal tube upto 9-mm ID. The guide
walls are flexible so that the airway can be
removed from around the tracheal tube after
intubation has been completed. The proximal end
is tubular so that it can function as a bite block.
The distal half of the airway has no posterior wall.
This provides an open space in the oropharynx in
which the distal end of the fiberscope can be
maneuvered. It is not necessary to remove the
tracheal tube connector when using this airway
for fibreoptic intubation.
 Williams Airway Intubator
 Designed for blind orotracheal
intubations
 Aid fiberoptic intubations or as an
oral airway
 Plastic
 #9 and #10 - 8.0 or 8.5 (ID)
tracheal tube
 The proximal half is cylindrical,
while the distal half is open on its
lingual surface.
 A comparison of the Williams
airway intubator with the
Ovassapian fiberoptic intubating
airway found that the Williams
airway intubator provided a better
view of the glottis in a significant
number of patients
 Williams Airway Intubator
 Designed for blind orotracheal
intubations
 Aid fiberoptic intubations or as an
oral airway
 Plastic
 #9 and #10 - 8.0 or 8.5 (ID)
tracheal tube
 The proximal half is cylindrical,
while the distal half is open on its
lingual surface.
 A comparison of the Williams
airway intubator with the
Ovassapian fiberoptic intubating
airway found that the Williams
airway intubator provided a better
view of the glottis in a significant
number of patients
PATIL-SYRACUSE ORAL AIRWAY
OR PATIL ENDOSCOPIC AIRWAY
 Designed for aid in fibreoptic
intubation.
 Lateral suction channels

 Groove in the center of the

lingual surface to allow
passage of fiberscope & guide
it in the midline
 A slit in the distal end allows
the fiberscope to be
manipulated in the
anteroposterior direction.
 Nasopharyngeal Airways
 Better tolerated than an oral
airway if the patient has intact
airway reflexes.
 Teeth are loose or in poor
condition or there is trauma or
pathology of the oral cavity
 Restricted mouth opening
 Contraindications to using a
nasopharyngeal airway include
anticoagulation; a basilar skull
fracture; pathology, sepsis, or
deformity of the nose or
nasopharynx; or a history of
nosebleeds requiring medical
treatment.
Insertion – Nasopharyngeal
airways

 Rule out limiting

factors
 Check size

 Check patency

 Lubricate

 Vasoconstrictor

 Position

 Direction
MODIFICATIONS
The Linder nasopharyngeal (bubble-
tip) airway

 Plastic with a large

flange
 The distal end has no
bevel
 Introducer, which has a
balloon on its tip
 No latex
 ADVANTAGES OF
NASOPHARYNGEAL AIRWAYS
 Nasal airways are better tolerated in a semi-
awake patient than an oral airways & are less
likely to be accidentally displaced or
removed.
 They offer an alternative to the oral airway
when the patient has limited mouth opening,
awkward or fragile dentition, trauma or
pathology of the oral cavity, or where oral
airways are frequently displaced by a
marked overlapping bite.
 They have also been used to aid in
pharyngeal surgery, to apply CPAP, to
facilitate suctioning, to reduce trauma while
passing a fibreoptic bronchoscope & to help
in management of Pierre Robin syndrome.
 Bite block
 Bite blocks should be placed between the
teeth or gums (preferably in the molar area)
to prevent occlusion of a tracheal tube or
damage to a fiberoptic endoscope or to keep
the mouth open for suctioning

 This bite block is designed to be placed

between the molar teeth with the flat
portion extending toward the side of the
face. The flat portion is used to grip for
insertion and removal.

 “Around the tube" bite block

 For short-term intubation or bronchoscopy
 Fits 5-9 mm tubes
 May lead to crimping of ETT or occlusion of
pilot balloon tube
 LARYNGOSCOPES
 Laryngoscopes are devices that have been
designed to visualize the interior of the
larynx including the vocal cords so as to aid
endotracheal intubation

 Direct Laryngoscopy
 “Line of Sight”
 Indirect Laryngoscopy
 “Around the corner”
 Optic device – mirror, prism
 Fiberoptics – rigid or flexible
 LARYNGOSCOPE
 1880 MacEwen – digital intubation
 1895 - First direct-vision instrument -Alfred
Kirstein (German laryngologist)
 1907 - Chevalier Jackson (US laryngologist
1865-1958)
 1940s - Ivan Magill and Robert Reynolds
Macintosh
 1970s - FOB
 1980s - Bullard Laryngoscope
 1990s – Rigid fiberoptic scopes
 Fiberoptic stylets
 Video-assisted devices
 Types
 Direct Laryngoscope  Flexible Fiberoptic
 Curved blades Bronchoscope
-Macintosh
 Rigid Indirect
 Straight blades –
Laryngoscope and
Miller
 Angulated blades –
stylets
 Optically assisted –
McCoy, Belscope,
Flexi prisms, mirrors
 Fiberoptic - Bullard,
 Specific
modifications Wu
 Reduced step-
 Stylets – Bonfils,

Bizzari Guffrida, Shikani

Racz Allen  Video assisted -
 Polio blades, Glidescope
 Parts
 Handle
1. Contains battery
power source.
2. Fibreoptic scopes
contain a fibreoptic
bundle in the blade.

 Blade
1. Base: attaches to
handle
2. Tongue: usually
perpendicular to the
handle, can be either
straight (for placement
posterior to the
epiglottis) or curved (for
anterior placement);
most are
interchangeable.
3. Web: contains
electrical connections
and bulb.
 Blades

Easier intubation Better laryngeal visualisation

Polio
Macintosh Miller Wisconsin

McCoy
MACINTOSH
 Robert Reynolds Macintosh (1897-1989), New
Zealand-born anaesthetist, became the first
British Professor of Anaesthetics in Oxford in
1937. He designed his laryngoscope, spray,
endobronchial tube and vaporiser.
The tongue, web and flange form a reverse Z
shape in cross-section. It is the most
commonly used blade in the UK. The
curvature of the blade allows the tip to fall
naturally into position in the vallecula of the
patient and the wide flange assists in holding
the tongue safely aside during intubation. A
‘left-sided’ version is available. It is used in
patients with right-sided facial deformities
making the use of the right-sided blade
difficult.
POLIO MACINTOSH BLADE
 The blade is mounted at 135 degrees to the
handle. This equipment was originally
designed to facilitate intubation in patients
encased within iron lung ventilators during
the polio epidemic. It is also useful in
patients with barrel chest, restricted neck
mobility or breast hypertrophy. These blades
are more popularly used in conjunction with
a short ‘stubby’ handle.
IVAN WHITESIDE MAGILL (1888-1986)
 Irish-born anaesthetist,
responsible for much
of the innovation and
development of
modern anaesthesia.
 Helped found the
Association of
Anaesthetists
 Professional exams in
anaesthesia
 U-shaped in cross
section
 Most commonly used
straight blade.
WISCONSIN BLADE
 Larger than the
Magill blade.
Features a more
open rear profile,
allowing even
greater
visualisation than
the Miller blade.
Also popular in
USA. (Also available
for paediatric
patients)
Lighting considerations
 Better illumination –
distal bulbs, not
fiberoptic blades
 Larger area of
illumination
 Fiberoptic blades – cool
Lux meter
and secure light source
 Washing and 90deg C
disinfecton
 Steam sterilsation at
134deg C 200-300
cycles
ALIGNING THE AXES

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IDEAL POSITIONING

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Sniffing position

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o Neck - Flexion
o Atlanto occipital joint
-Extension
Laryngoscopy
Laryngoscope Blade
Position

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