1.

Endotracheal tube (ETT)

2. Flexometallic tube (FMT)
3. Laser-Flex® Tracheal Tube
4. Microlaryngeal Tracheal Tube (MLT)
5. Oral Rae Endotracheal Tube
6. Nasal Rae Endotracheal Tube
7. Double-lumen endo-bronchial tubes
8. Laryngeal mask airways
9. LMA Supreme
10. LMA Proseal
11. LMA Fastrach
12. LMA Flexible
13. LMA Ambu
14. LMA Cobra
15. LMA I-Gel
16. LMA Buska
Endotracheal Tube (ETT)

 First line advanced airway tube to maintaining an

airway.
 Used in patients without a gag reflex to maintain and
protect the airway
 Provides for optimum ventilation and oxygenation
 Ventilate the patient after the tube is in place
 Confirm chest rise and breath sounds frequently
Flexometallic Tube
Features and specification:

 Material: Non-toxic,medical grade PVC material kink-resistant;

 With Cuff size ranging from 5.0mm to 9.5mm; Without Cuff size
ranging from 3.0mm to 9.5mm;

 High volume, low pressure cuff; high level of tactile feedback

from pilot balloon.

 Transparent tube with visible markings for easy observation;

 Spiral stainless steel reinforcing wire within tube wall reduces risk of
crushing or kinking;

 Smoothly finished tube tip minimizes trauma during intubation;

 Tube and cuff welds for ease of intubation and extubation;

 Murphy Eye smoothly formed to allows ventilation in the event of

obstruction of the end of the tube during intubation;

 15mm connector conforming to ensuring full compatibility with circuit

connections;

 Smooth inner wall of tube resists secretion adherence and ensures

ventilation;

 Flexible to confirm to patient position; optimum choice for surgery

when bending or compression of the tube is likely to occur
Laser-Flex ® Tracheal Tube
 Stainless steel body is airtight, flexible and laser-
resistant.
 Reflected beams from the tube are defocused to
reduce accidental laser strikes to healthy tissue.
 Smooth surface and Magill curve minimize trauma
during intubation.
 Patented double cuff design helps assure tracheal seal
should the upper cuff be struck by laser beam.
 Standard features:
 High-volume low-pressure cuffs (cuffed)
 Full Magill curve
 Murphy tip and eye (cuffed)
 Smooth beveled tip
 Individually labeled pilot balloon and mechanical self-
sealing valve (cuffed)
 Laser surgery of the larynx or other areas in close
proximity to the tracheal tube using CO2 or laser beam

 Laser resistant tube in soft white rubber, with hooded

tip, Murphy eye, double cuff, laser-guard foil, approx.
17cm long,

 sponge and micro-corrugated silver foil, integral

connector, Magill form, two-way stopcocks with lock
in position.
Characteristics and Advantages
 Designed to allow maximum access and optimum visibility
with the operating site, while maintaining controlled
ventilation.
 The tube shaft has a special laser-guard of approx. 17cm in
length proximal to the cuff. Before intubation,
 Isotonic-saline solution. This will prevent the laser
beam from penetrating or igniting the tube material.
 By the use of a special material, both cuffs are
characterized by an excellent resistance to the
diffusion of anesthetic gas.
 This diffusion resistance considerably diminishes the
possibility of pressure increasing in the cuffs during
anesthesia.
 Risk of mucosa lesions in the trachea is reduced to a
minimum. The hooded tip makes it possible to smoothly
introduce the tube into the trachea.
Normal Saline

Methylene blue
MLT® Microlaryngeal Tracheal Tube
 Standard tube length and cuff size with provide greater
access to surgical field.
 Smaller diameter is also beneficial where airway has been
narrowed by a tumor or other abnormality.
 Standard Features:
 High-volume low-pressure cuff
 Murphy tip and eye
 Full Magill curve
 Smooth beveled tip
 Tip-To-Tip® radiopaque line
 Pilot balloon with mechanical self-sealing valve
 Indications For Usage
 Microlaryngeal surgery

 A large-diameter cuff effectively seals the trachea at

low pressure to permit optimum ventilation with
reduced risk of aspiration or tracheal damage
 MLT tube, when inserted through nasal route, offers
adequate space in front of the tube for proper
vision, excision and hemostasis of vocal cord lesions
in the anterior and middle third portions as compared
to oral route.

 There is less risk of kinking of tube at the point of

securing with skin and it provides easy
instrumentation for exposure of oral cavity.

 MLT tube placed nasally lies in the posterior

comissure of vocal cord between arytenoids,
leaving anterior two-third or more unobscured
Oral Rae Endotracheal Tube
 This endotracheal tube with a preformed acute-
angle bend is unique because the bend is part of the
tube that remains external to the patient.

 The inherent flexibility of the tube allows it to be

intentionally inserted deeper into the trachea if
desired. Tube may be straightened to facilitate
tracheal suctioning.
 The preformed bend eliminates the possibility of tube
kinking at the point of the bend during removal of all
connections and adapters from the immediate area
around the face.

 The preformed bend not only allows better access by

the surgeon during head and neck surgery but also
prevents injury to the patient from the pressure of
metal connectors.
Product Features
 Unique design assures patent airway while reducing
risk of kinks and disconnects.
 Rectangular mark at preformed curve aids correct
positioning.
 Curve can be temporarily straightened to allow easy
passage of suction catheters.
 Available in both cuffed and uncuffed styles.
Indications For Usage
 Nasal surgery
 Ophthalmic surgery
 Facial surgery
Nasal Rae Endotracheal Tube
 Nasotracheal intubation is used in patients undergoing
maxillofacial surgery or dental procedures or when
orotracheal intubation is not feasible.
 Nasotracheal intubation used to be the preferred route for
prolonged intubation in critical care units, but nasal
damage, sinusitis and local abscesses have limited its use.
 Because of the necessity of longer and narrower tubes for the
nasal route, pulmonary toilet is more difficult and airway
resistance is greater.
 The nasal route in the spontaneously ventilating patient was
once considered a technique of choice for emergency operations,
but orotracheal intubation under direct vision following the
rapid sequence induction of anesthesia is now the technique of
choice.
Indications
 Most commonly, this technique is employed in the
operating room for dental procedures and intraoral and
oropharyngeal surgeries. Some authors advocate using
nasotracheal intubation for minor otolaryngologic and
maxillofacial surgeries, as they believe the technique is
under used in the current practice.

 Securing the airway in patients with questionable

cervical spine stability or severe degenerative cervical
spine disease, patients with intraoral mass lesions or
structural abnormalities, and patients with limited
mouth opening (eg, trismus).
contraindications
Absolute contraindications
 Suspected epiglottitis
 Midface instability
 Coagulopathy
 Suspected basilar skull fractures
 Apnea or impending respiratory arrest.
Relative contraindications
 Large nasal polyps
 Suspected nasal foreign bodies
 Recent nasal surgery
 Upper neck hematoma or infection
 History of frequent episodes of epistaxis
 Prosthetic heart valves
Complication
 Epistaxis
 Damage to nasal cavity
 Aspiration
 Vagal stimulation
 Laryngospasm
 Vocal cord damage
 Bacteremia from introduction of nasal flora to the
trachea
 Pneumothorax
Double-lumen endo-bronchial
tubes
 Double-lumen endo-bronchial tubes for Thoracic
surgery. These allow single-lung ventilation while the
other lung is collapsed to make surgery easier. The
deflated lung is re-inflated as surgery finishes to check
for fistulas (tears).
Laryngeal mask airways
 The laryngeal mask airway is a supraglottic airway device.

 Laryngeal mask airways come in a variety of sizes ranging from large

adult (size 5) to infant (size 1).

 The laryngeal mask functions as a "peripharyngeal sealer," in contrast

to another category of supraglottic airways which are "base on tongue
sealers”.

 A newer generation of the laryngeal mask actually utilizes both airway

sealing mechanisms (peripharyngeal sealing and base of tongue sealing).

 The cuff follows the natural bend of the oropharynx, and is seated over
the pyriform fossae. Once placed, the cuff around the mask is inflated
with air to create a tight seal.

 Air entry is confirmed by listening for air entry into the lungs with a
stethoscope, by presence of end tidal carbon dioxide and by monitoring
the degree and pressure at which the air leaks around the mask in the
oropharynx.
LMA Supreme
 The LMA Supreme® is intended for use in achieving
and maintaining control of the airway during
routine anaesthesia and when tracheal
intubation fails in non-fasted patients during
anaesthetic procedures.
 It is also intended for use in cardiopulmonary
resuscitation procedures as well as in the "failed
intubation" and the "can’t intubate-can’t ventilate"
situation.
Benefits of the LMA Supreme®
 Unique elliptical airway tube. Easy placement. Stable airway
in situ. No kinking.
 Larger pre-curved cuff ensures laryngeal fit and effective seal.
 Over-moulded distal cuff reinforcing tip prevents tip fold-over
.
 Integral bite-block.
 Clear airway tube so that any obstruction can be seen.
 Drain tube.
 Fixation tab ensures tip engagement with upper oesophageal
sphincter.
 Epiglottic Fins prevent epiglottis from obstructing airway.
.
The LMA ProSeal
 The LMA ProSeal™ is a reusable supraglottic airway device that
incorporates a gastric drainage tube placed lateral to the main
airway tube and which ends at the tip of the mask

 The gastric drainage tube is designed to separate the

gastrointestinal and respiratory tracts, allowing regurgitated fluid
to pass up the drain tube and bypass the glottis, thereby protecting the
airway from soiling in the event of passive regurgitation.

 An important additional design feature is that a second, dorsally-

located, cuff helps improve the airway seal, a particularly useful
feature when positive pressure ventilation is desired. These design
features were intended to achieve a better seal than an ordinary
LMA permits, allowing patient ventilation using higher-than-
usual airway pressures, as well as to reduce the of aspiration
LMA Fastrach ™
 Designed for emergency airways and for
cardiopulmonary resuscitation.
 facilitates continuous ventilation and intubation.
With precious few seconds available to choose a
backup airway device, the decision is a critical one.
 That’s why the LMA Fastrach™ is the undisputed
choice of medical professionals in more than 35
countries for the difficult airway.
 Special design features of the LMA Fastrach™ that
facilitate intubation, blind or fiberoptic, include:
 Rigid, anatomically curved, airway tube that is wide
enough to accept an 8.0 mm cuffed ETT and is short
enough to ensure passage of the ETT cuff beyond the vocal
cords
 Rigid handle to facilitate one-handed insertion, removal,
and adjustment of the device's position to enhance
oxygenation and alignment with the glottis
 Epiglottic elevating bar in the mask aperture which
elevates the epiglottis as the ETT is passed through and a
ramp which directs the tube centrally and anteriorly to
reduce the risk of arytenoid trauma or esophageal
placement
Other benefits:
 Available in three sizes, one size for children, two sizes
for adults
 LMA Fastrach™ comes with a specially designed
reusable LMA Fastrach™ ETT
The LMA Flexible™
 The LMA Flexible™ has a wire-reinforced, flexible airway tube
that allows it to be positioned away from the surgical field while
minimizing loss of seal.
 Available in reusable or single use, the LMA Flexible™is
particularly useful in adult and pediatric procedures where the
surgeon and anesthesiologist are competing for access, such as
those involving the head or neck.
 It also acts as a barrier against soiling of the glottis or trachea by
blood or secretions from above, making it possible to use
the LMA Flexible™ for intra-oral and nasopharyngeal
operations.
 While the airway tube of the LMA Flexible™ has a smaller
diameter than the other LMA™ devices, its internal diameter is
comparable to those found in commonly used endotracheal
tubes
Clinical benefits:
 Suitable for head and neck procedures

 Airway tube may be positioned away from surgical

field without loss of seal

 Wire-reinforced tube resists kinking and cuff

dislodgment

 Available in pediatric and adult sizes

 The unique design of LMA Flexible™ allows the tube to
be moved out of the surgical field without
displacement of the cuff, or loss of seal for the
anaesthetist.
 LMA Flexible™ allows the tube complete flexibility and
resistance to compression so that the head and neck
can be turned without dislodging the mask.
 LMA Flexible™ makes it possible to operate in the mouth
or throat with the benefits of an LMA™ airway and can be
considered across a range of procedures including:
 Bilateral Myringotomy Tubes
 Rhinoplasty
 Nasal Sinus Surgery
 Adenoidectomy
 Tonsillectomy
Ambu LMA
 The Ambu Disposable Laryngeal Mask features a
special curve that carefully replicates natural
human anatomy. This ensures that the patient's head
remains in a natural, supine position when the mask is
in use.
Here are just some of the many benefits:
 Built-in antomically correct curve for easy atraumatic
insertion
 Reinforced tip resists folding over during insertion and
plugs the upper esophageal sphincter
 Cuff and airway tube molded as single unit for extra
safety - no separation
 Extra-soft cuff ensures the best possible seal with the
least possible mucosal pressure
 Pilot balloon identifies mask size and provides precise
tactile indication of degree of inflation
 Ergonomically shaped airway tube for firm and
ergonomical grip during insertion
 Convenient depth marks for monitoring correct
position
 Packaged sterile and ready for use
 Colour coded pouch with directions for use
 Available in 8 sizes fitting a wide range of patients
COBRA LMA
 The Cobra is easy to insert, works well, and
provides higher seal pressures than the LMA does,
which can be important when airway resistance is
high
 The observed differences in anatomic fit are difficult to
interpret and might not matter clinically, particularly
in the emergency department, where these devices
usually are placed for a short time as a rescue
maneuver.
 Extraglottic devices are key components of the rescue
strategy for failed airways in adults and children,
I gel LMA
 i-gel is the innovative second generation supraglottic airway from
Intersurgical launched in 2007. The first major development since the
laryngeal mask airway, the i-gel changed the face of airway
management and is now widely used in anaesthesia and resuscitation
across the globe.

Why use i-gel?

 Ease and speed of insertion
 Reduced trauma
 Superior seal pressure
 Gastric access
 Integral bite block
 Non-inflatable cuff
What makes i-gel unique?
 i-gel has a soft, gel-like, non-inflatable cuff,
designed to provide an anatomical, impression fit
over the laryngeal inlet. The shape, softness and
contours accurately mirror the perilaryngeal anatomy.
This innovative concept means that no cuff inflation is
required.
 The i-gel works in harmony with the patient’s
anatomy so that compression and displacement
trauma are significantly reduced or eliminated.
LMA BASKA
 The Baska Mask is equipped with a self-sealing cuff
and gastric reflux overflow protection using a
sump reservoir and self-venting channels making
gastric tube insertion superfluous.
THE END