Laryngeal Tube

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Volker Dorges - One of the best experts on this subject based on the ideXlab platform.

  • a comparison of the proseal Laryngeal mask airway the Laryngeal Tube s and the oesophageal tracheal combiTube during routine surgical procedures
    European Journal of Anaesthesiology, 2005
    Co-Authors: Berthold Bein, M Steinfath, S Carstensen, M Gleim, L Claus, P H Tonner, J Scholz, Volker Dorges
    Abstract:

    SummaryBackground and objective:This study was performed to compare three supraglottic airway devices: the ProSeal Laryngeal mask airway (PLMA), the Laryngeal Tube S (LTS) and the oesophageal-tracheal combiTube (OTC) during routine surgical procedures.Methods:Ninety American Society of Anesthesiolog

  • the Laryngeal Tube s a modified simple airway device
    Anesthesia & Analgesia, 2003
    Co-Authors: Volker Dorges, Hartmut Ocker, Volker Wenzel, M Steinfath, Klaus Gerlach
    Abstract:

    The recently introduced single-lumen Laryngeal Tube can be inserted without additional equipment, and was proven in bench models (1,2) and preliminary clinical trials, to effectively ventilate and oxygenate patients with respiratory arrest (3,4) undergoing routine induction of anesthesia. Thus, the

  • a comparison of the Laryngeal Tube with the Laryngeal mask airway during routine surgical procedures
    Anesthesia & Analgesia, 2002
    Co-Authors: Hartmut Ocker, Volker Wenzel, M Steinfath, P Schmucker, Volker Dorges
    Abstract:

    The Laryngeal mask airway (LMA; Laryngeal Mask Company, Henley-on-Thames, UK) is an established airway device, whereas the Laryngeal Tube (LT) is relatively new and therefore not as well investigated. Therefore, the purpose of the present prospective, randomized, controlled trial was to compare the

  • Intubating Laryngeal mask airway, Laryngeal Tube, 1100 ml self-inflating bag-alternatives for basic life support?
    Resuscitation, 2001
    Co-Authors: Volker Dorges, Hartmut Ocker, Volker Wenzel, Theo Schumann, Eicke Neubert, Klaus Gerlach
    Abstract:

    Abstract Insufficient oxygenation, ventilation and gastric inflation with subsequent regurgitation of stomach contents is a major hazard of bag-valve-face mask ventilation during the basic life support phase of cardiopulmonary resuscitation (CPR). The European Resuscitation Council has recommended smaller tidal volumes of ∼500 ml as an effort to reduce gastric inflation; furthermore, the intubating Laryngeal mask airway and the Laryngeal Tube have been recently developed in order to provide rapid ventilation and to secure the airway. The purpose of our study was to examine whether usage of a newly developed medium-size self-inflating bag (maximum volume, 1100 ml) in association with the intubating Laryngeal mask airway, and Laryngeal Tube may provide adequate lung ventilation, while reducing the risk of gastric inflation in a bench model simulating the initial phase of CPR. Twenty house officers volunteered for our study. When using the Laryngeal Tube, and the intubating Laryngeal mask airway, respectively, the medium-size (maximum volume, 1100 ml) versus adult (maximum volume, 1500 ml) self-inflating bag resulted in significantly ( P

  • Emergency airway management by intensive care unit nurses with the intubating Laryngeal mask airway and the Laryngeal Tube
    Critical Care, 2000
    Co-Authors: Volker Dorges, Volker Wenzel, Eicke Neubert, Peter Schmucker
    Abstract:

    When using the Laryngeal Tube and the intubating Laryngeal mask airway (ILMA), the medium-size (maximum volume 1100 ml) versus adult (maximum volume 1500 ml) self-inflating bags resulted in significantly lower lung tidal volumes. No gastric inflation occurred when using both devices with either ventilation bag. The newly developed medium-size self-inflating bag may be an option to further reduce the risk of gastric inflation while maintaining sufficient lung ventilation. Both the ILMA and Laryngeal Tube proved to be valid alternatives for emergency airway management in the experimental model used.

T M Cook - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of the revised Laryngeal Tube suction the Laryngeal Tube suction ii in 100 patients
    BJA: British Journal of Anaesthesia, 2007
    Co-Authors: R Mihai, G Knottenbelt, T M Cook
    Abstract:

    Background We prospectively assessed the performance of the Laryngeal Tube suction mark II (LTS II). Methods LTS II was assessed during controlled and spontaneous ventilation during total i.v. anaesthesia. Ventilation adequacy, functional and anatomical positioning and airway seal were evaluated. Results One hundred healthy patients (30F:70M) aged 18–85-yr-old were studied. Insertion of the LTS II was successful in 71 at first attempt, in 24 at second attempt and in five at third/fourth attempt. Median insertion time was 15 s (range 5–120 s). Temporary obstruction occurred in six patients. A median of one manipulation per patient was required to establish an airway (range 0–5). During maintenance, temporary airway obstruction occurred in eight patients. Use of the device was abandoned once during insertion, once during maintenance and once because of complications unrelated to the study. The airway was clear in 89 of 97 patients during maintenance and partially obstructed in eight. Median seal pressure was 29.5 (range 15–85) cm H2O. A gastric Tube was passed via the posterior channel in 97 of 99 patients. The glottis was visible using a fibrescope passed via the device in 51% of patients. Via the drain Tube the upper oesophagus was visible in 22% and this was open in 50%. Blood was visible on the device after removal in 12 patients. After the operation 14 patients reported mild sore throat. Discussion The LTS II appears to be an improvement on its predecessor and merits further investigation comparing it with its competitors during use for anaesthesia and emergency airway management.

  • randomized crossover comparison of proseal Laryngeal mask airway with Laryngeal Tube sonda during anaesthesia with controlled ventilation
    BJA: British Journal of Anaesthesia, 2005
    Co-Authors: T M Cook, J Cranshaw
    Abstract:

    Background The Laryngeal Tube Sonda ® (LTS) is a supraglottic airway which, like the ProSeal ® Laryngeal Mask Airway (PLMA), incorporates a drain Tube. We compared the performances of LTS and PLMA during controlled ventilation anaesthesia. Methods The devices were studied in 32 ventilated patients by randomized crossover trial. Primary outcome was airway seal pressure. Secondary outcomes included insertion success and time, manipulations required, ventilation quality, peak and plateau airway pressures, ability to pass a gastric Tube and fibreoptic Laryngeal view. Results The PLMA produced a higher seal pressure (median values, PLMA 26 cm H 2 O and LTS 24 cm H 2 O, P P >0.05). The PLMA required fewer manipulations ( P P P P P P P Conclusion The difference in seal pressure between devices was clinically unimportant. However, the LTS had an unexpectedly high failure rate. PLMA performance exceeded LTS performance in many clinically useful measures. The PLMA has greater clinical utility than the LTS during controlled ventilation.

  • randomized crossover comparison of the prosealtm Laryngeal mask airway with the Laryngeal Tube during anaesthesia with controlled ventilation
    BJA: British Journal of Anaesthesia, 2003
    Co-Authors: T M Cook, C Mckinstry, R Hardy, S Twigg
    Abstract:

    Background The Laryngeal Tube (LT®) performs similarly to the classic Laryngeal mask airway during controlled ventilation but with an improved airway seal. We compared the Laryngeal Tube with the ProSeal™ Laryngeal mask airway (PLMA) throughout anaesthesia. Methods Thirty-two patients were studied using a randomized cross-over design. The primary outcome measure was airway seal pressure. Secondary outcome measures included peak and plateau airway pressures, time to achieve an airway, ease of insertion, airway manipulations required to achieve a patent airway and grade of fibre-optic laryngoscopy. The proportion of patients in whom good, fair or failed ventilation was achieved was also calculated. Results No significant difference was found in regard to seal pressure (PLMA, median 26.5 cm H2O, range 10–40; LT, median 24, range 6–40; P=0.7, 95% confidence interval of the difference 3.5 to –4.0). There were two failures of insertion or ventilation in the LT group and none in the PLMA group. The peak airway pressure with the PLMA was lower than with the LT but the difference was clinically unimportant (PLMA, mean 16.2 cm H2O, sd 3.52; LT, mean 17.9, sd 5.21; P=0.02, 95% confidence interval of the difference –3.1 to –0.28). The PLMA took significantly less time to insert than the LT (PLMA, median 18.5 s, interquartile range 14–26; LT, median 22, interquartile range 15–36.5; P Conclusion The two devices performed equally well in terms of seal pressure. The PLMA was quicker to insert. Efficacy of ventilation was significantly better with the PLMA than the LT. The PLMA allowed a significantly better view of the larynx with a fibre-optic laryngoscope, and may therefore be of more use in cases where visualization of the larynx is required.

  • randomized comparison of Laryngeal Tube with classic Laryngeal mask airway for anaesthesia with controlled ventilation
    BJA: British Journal of Anaesthesia, 2003
    Co-Authors: T M Cook, B. Mccormick, Takashi Asai
    Abstract:

    Background. Only a prototype Laryngeal Tube has been compared with the classic LMA † for brief periods of anaesthesia. We compared the new Laryngeal Tube (which had several improvements in design) with the classic LMA. Methods. We randomly allocated 72 patients to receive either the Laryngeal Tube or an LMA, and compared adequacy of controlled ventilation during anaesthesia (good: clear airway without complications; fair; clear airway with complications or suboptimal airway; or failed), leak pressure and the incidence of postoperative complications. Results. Insertion was successful within 2 attempts in all 36 patients for the classic LMA and in 35 patients for the Laryngeal Tube. The mean leak pressure for the Laryngeal Tube (28 cm H2O) was significantly greater than that for the classic LMA (21 cm H2O) (P<0.001; 95% CI 3.6‐10.0 cm H2O). Ventilation was good in 25 cases, fair in 11, and failed in no patients with the classic Laryngeal mask airway; and good in 23, fair in 11 and failed in two for the Laryngeal Tube. There was no significant difference in adequacy of ventilation between the groups. The median peak airway pressure for the Laryngeal Tube (17.5 cm H2O) was greater than that for the classic LMA (16 cm H2O) (difference: 2 cm H2O; 95% CI 0‐5 cm H2O). There was no significant difference in the incidence and severity of the postoperative complications between the two groups.

  • use of the Laryngeal Tube in 100 patients
    Acta Anaesthesiologica Scandinavica, 2003
    Co-Authors: Takashi Asai, Koh Shingu, T M Cook
    Abstract:

    Background: The Laryngeal Tube has a potential role during anaesthesia, but there have been only a few studies assessing its efficacy during the entire course of anaesthesia, and all previous studies used prototypes. We studied 100 patients to assess the efficacy of a new Laryngeal Tube during the entire course of anaesthesia. Methods: After induction of anaesthesia, the Laryngeal Tube was inserted (up to two times) and adequacy of ventilation was assessed. The airway pressure at which gas leaked around the device was measured. The device was used during anaesthesia, while ventilation was controlled. The device was removed after the patient had opened the mouth to verbal command. Any complications during and after anaesthesia were recorded. Results: Ventilation was possible at the first attempt in 90 patients, at the second attempt in another seven patients, and adequate ventilation failed after two attempts in three patients. Median (interquartile range) leak pressure was 28 (22—30) cmH2O. In all 97 patients, the Laryngeal Tube was used until the end of surgery. However, in two of the 97 patients the airway was partially obstructed during anaesthesia and it was necessary to reposition the device. The Laryngeal Tube was tolerated well during emergence from anaesthesia. No hypoxia, regurgitation, vomiting or laryngospasm occurred in any patient. On removal of the Laryngeal Tube, no blood was detected on the device and no apparent ischaemic changes to the tongue were observed in any patient. Post-operatively, six patients complained of a mild sore throat, and no patient complained of difficulty in swallowing or numbness of the oropharynx. Conclusion: The Laryngeal Tube can be useful for maintaining a patent airway during anaesthesia.

Takashi Asai - One of the best experts on this subject based on the ideXlab platform.

  • Cricoid pressure prevents placement of the Laryngeal Tube and Laryngeal Tube-suction II
    BJA: British Journal of Anaesthesia, 2007
    Co-Authors: Takashi Asai
    Abstract:

    Background The Laryngeal Tube has a potential role in patients with a difficult airway, but cricoid pressure is required if the patient is at risk of aspiration. The effect of cricoid pressure on insertion of these devices is unknown. Methods In a randomized cross-over study, the Laryngeal Tube (25 patients) or the Laryngeal Tube-suction II (15 patients) was inserted with cricoid pressure applied on one occasion and with sham pressure on the other occasion. Adequacy of ventilation, time to achieve adequate ventilation, and the leak pressure were assessed. Results Ventilation was adequate in all patients when sham pressure was applied. Cricoid pressure significantly reduced the rate of adequate ventilation to 6 of 25 patients for the Laryngeal Tube [ P P 2 O for sham pressure and 15.5 (14.3–20.5) (12–22) cm H 2 O for cricoid pressure. Conclusions Continuous cricoid pressure prevents correct placement of the Laryngeal Tube and the Laryngeal Tube-suction II such that placement and ventilation via these devices are ineffective. The effect of cricoid pressure on ventilation via these devices, after correct placement, remains unknown.

  • the Laryngeal Tube
    BJA: British Journal of Anaesthesia, 2005
    Co-Authors: Takashi Asai, Koh Shingu
    Abstract:

    The Laryngeal Tube (VBM Medizintechnik, Sulz, Germany) is a relatively new extraglottic airway, designed to secure a patent airway during either spontaneous breathing or controlled ventilation. In this review article, we have assessed the potential role of the Laryngeal Tube during anaesthesia and during cardiopulmonary resuscitation. There are four variations of the Laryngeal Tube: standard Laryngeal Tube, disposable Laryngeal Tube, Laryngeal Tube-Suction II and disposable Laryngeal Tube-Suction II. The design of the device has been revised several times. Insertion of the standard Laryngeal Tube is as easy as with the Laryngeal mask airway classic. The Laryngeal Tube may provide a better sealing effect than the Laryngeal mask. The incidence of complications with the two devices is similar, although the Laryngeal Tube may require more re-adjustments of its position to obtain a clear airway. Compared with the ProSeal™ Laryngeal mask, the Laryngeal Tube may be less effective. The efficacy of the standard Laryngeal Tube is unclear, particularly in patients breathing spontaneously or in children. The efficacy of the Laryngeal Tube Suction-II and disposable devices is also not clear. From the limited number of studies and reports available, it can be concluded that the Laryngeal Tube is potentially useful in maintaining a clear airway during anaesthesia and cardiopulmonary resuscitation. In addition, the device may be useful as an aid to tracheal intubation.

  • Appropriate cuff volumes of the Laryngeal Tube
    Anaesthesia, 2005
    Co-Authors: Takashi Asai, Koh Shingu
    Abstract:

    Summary The manufacturer of the Laryngeal Tube (VBM, Germany) states that the cuffs should be inflated until the intracuff pressure reaches 60 cmH2O or with a certain volume of air (60 ml for the size 3 and 80 ml for size 4). We studied 100 patients to investigate this. In addition, we examined whether the patient’s height or weight could be a predictor of the required volume. Following insertion of a Laryngeal Tube, the cuff volume at the intracuff pressure 60 cmH2O was measured. The mean (SD) volume was 62 (7.2) ml for size 3 and 84 (11.2) ml for size 4. There was a correlation between the height of the patient and the cuff volume (correlation coefficient = 0.64; p < 0.01; volume (ml) = )86.5 + 1.02 height (cm)), and between the patient’s weight and the cuff volume (correlation coefficient = 0.37; p < 0.01; volume (ml) = 45.3 + 0.558 weight (kg)). The required volume for size 3 was < 60 ml in nine of 27 patients (33%), and for size, 4 < 80 ml in 20 of 73 patients (27%). Our results support the manufacturer’s recommended cuff volumes, but if the cuff is inflated with these fixed volumes (60 ml and 80 ml), the cuff would be overinflated in one-third of patients, increasing the theoretical risk of ischaemic changes to the oropharynx. Since the cuff volume is correlated with the patient’s height or weight, the cuff volume should be adjusted to the patients’ stature.

  • Ease of insertion of the Laryngeal Tube during manual‐in‐line neck stabilisation
    Anaesthesia, 2004
    Co-Authors: Takashi Asai, A. G. Marfin, J. Thompson, Mansukh Popat, Koh Shingu
    Abstract:

    Summary The Laryngeal Tube has a potential role in airway management during anaesthesia or cardiopulmonary resuscitation. In patients with unstable necks, the head and neck may need to be stabilised manually (manual in-line stabilisation), but it is not known whether this procedure affects the ease of insertion of the Laryngeal Tube. We studied, in a cross-over study, 21 adult patients to compare the success rate of ventilation through the Laryngeal Tube between the Magill position (a pillow under the occiput and the head extended) or the manual in-line position of the head and neck (without a pillow under the occiput). After induction of anaesthesia and neuromuscular blockade, the Laryngeal Tube was inserted in turn in the two positions. The ease of insertion was scored with four categories (easy, moderately difficult, difficult and impossible), and adequacy of ventilation through the device was assessed. Ventilation was adequate in all 21 patients in the Magill position, but only in two of 21 patients during manual in-line positionin ( p< 0.01; 95%CI for difference: 68‐94%). In the Magill position, insertion of the Laryngeal Tube was easy in 16 patients and moderately difficult in the remaining five patients; in the manual in-line stabilisation position, insertion was moderately difficult in two patients and impossible in the remaining 19 patients. Stabilisation of the patient’s head and neck by the manual in-line method made insertion of the Laryngeal Tube either difficult or impossible.

  • Time-related cuff pressures of the Laryngeal Tube with and without the use of nitrous oxide.
    Anesthesia & Analgesia, 2004
    Co-Authors: Takashi Asai, Koh Shingu
    Abstract:

    UNLABELLED: The Laryngeal Tube (VBM Medizintechnik, Sulz, Germany), a new supraglottic airway, consists of an airway Tube, two cuffs, and two distal apertures between the two cuffs. One concern with the use of this device is ischemic change to the oropharyngeal mucosa. We studied the time-course change of the intracuff pressure (which reflects the pharyngeal pressure) of the Laryngeal Tube during anesthesia with and without nitrous oxide. After insertion of a Laryngeal Tube, 24 patients were randomly allocated to 1 of 2 groups. In one group (group N or nitrous oxide group), 66% nitrous oxide was used, whereas in the other group nitrous oxide was not used (group A or air group). In both groups, sevoflurane was used to maintain anesthesia. Time-course changes of the intracuff pressure and postoperative airway complications were recorded. In group N, the intracuff pressure significantly increased over time (P < 0.001; the maximal pressure: 120 cm H(2)O), whereas in group A the intracuff pressure remained stable. The intracuff pressure was significantly higher in group N than in group A (P < 0.0001; 95% confidence intervals for difference: 6-20 cm H(2)O at 30 min). Postoperatively, two patients in group A and one patient in group N complained of mild sore throat. IMPLICATIONS: Nitrous oxide may increase pharyngeal pressure by the cuffs of the Laryngeal Tube, and thus it is advisable to monitor and adjust the intracuff pressure of the Laryngeal Tube during anesthesia to minimize possible ischemic changes to the oropharynx.

M Steinfath - One of the best experts on this subject based on the ideXlab platform.

Christian Byhahn - One of the best experts on this subject based on the ideXlab platform.

  • Laryngeal Tube suction for airway management during in-hospital emergencies.
    Clinics, 2017
    Co-Authors: Haitham Mutlak, Christian Byhahn, Kai Zacharowski, D Meininger, Christian F. Weber, Colleen Cuca, R. Schalk
    Abstract:

    OBJECTIVE: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation Laryngeal Tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. METHODS: During a seven-year period, patients treated with a Laryngeal Tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded. RESULTS: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the Laryngeal Tube during the first attempt. In 93% of patients (n=98), the Tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. CONCLUSIONS: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.

  • intubating Laryngeal Tube suction disposable initial clinical experiences with a novel device for endotracheal intubation
    Anaesthesist, 2016
    Co-Authors: M N Bergold, S Kahle, T Schultzik, M Bucheler, Christian Byhahn
    Abstract:

    BACKGROUND: According to the recent guidelines supraglottic airways, such as Laryngeal Tubes are recommended to ensure oxygenation in patients with unexpected difficult airways. The novel Intubating Laryngeal Tube Suction Disposable (iLTS-D) is a modified Laryngeal Tube designed for secondary tracheal intubation. This pilot study evaluated the use of the iLTS-D in clinical practice with respect to practicality and efficacy. METHODS: In this study the airways of 30 consecutive adult patients with no evidence of a difficult airway undergoing elective ear, nose and throat (ENT) surgery were managed with the iLTS-D. After induction of anesthesia the iLTS-D was placed in position and checked for correct ventilation. Following muscle relaxation, endotracheal intubation through the iLTS-D was performed under continuous visualization using a flexible bronchoscope. Finally, the iLTS-D was removed leaving the endotracheal Tube in place. Data were collected anonymously as part of a quality assurance program. Publication of the data was approved by the institutional review board. RESULTS: Initial iLTS-D placement took a median of 17 s (range 12-90 s) and provided sufficient ventilation in all patients; however, the position of the iLTS-D needed to be adjusted in four patients. Endotracheal intubation through the iLTS-D was achieved in 29 out of 30 patients at the first attempt (n = 23) or after 2 attempts (n = 6) and the median time required for intubation was 32 s (range 18-187 s). In five patients no Laryngeal structures could initially be identified by bronchoscopy. Blind endotracheal intubation through the iLTS-D was performed in two cases and in two other patients the endotracheal Tube was also blindly advanced but into the esophagus. After removal of the endotracheal Tube and repositioning of the iLTS-D, successful tracheal intubation was subsequently achieved under bronchoscopic vision. The procedure was aborted and uneventful conventional intubation using direct laryngoscopy was carried out in one patient. The median time for removal of the iLTS-D after successful intubation was 20 s (range 15-80 s). Minor blood stains on the iLTS-D were observed in three patients. With one exception, all problems and adverse events occurred during the first 10 patients. CONCLUSION: This first clinical study demonstrated that in patients with apparently normal airways and in the hands of users without previous experience, the iLTS-D allowed sufficient ventilation in all patients and had a high success rate for subsequent endotracheal intubation. The results are, however, preliminary until confirmed by further studies, particularly in patients with difficult airways.

  • emergency airway management in trauma patients using Laryngeal Tube suction
    Prehospital Emergency Care, 2011
    Co-Authors: R. Schalk, Felix Walcher, Kai Zacharowski, D Meininger, Miriam Ruesseler, D Oberndorfer, Leo Latasch, Christian Byhahn
    Abstract:

    AbstractBackground. Endotracheal intubation (ETI) is considered to be the “gold standard” of prehospital airway management of trauma patients. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers who are less experienced in ETI. Objective. To prospectively evaluate the feasibility of the use of Laryngeal Tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients. Methods. During a 40-month period, data for all cases of prehospital use of the Laryngeal Tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for Laryngeal Tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up. Results. Fifty-six o...

  • prehospital airway management of Laryngeal Tubes should the Laryngeal Tube s with gastric drain Tube be preferred in emergency medicine
    Anaesthesist, 2011
    Co-Authors: P Wilde, Christian Byhahn, Martin G Mack, R. Schalk
    Abstract:

    : Laryngeal Tubes (LT) are increasingly being used for emergency airway management. This article reports on two patients in whom out-of-hospital intubation with a single-lumen LT was associated with massive pulmonary aspiration in one patient and gastric overinflation in the other. In both cases peak inspiratory pressures exceeded the LT leak pressure of approximately 35 mbar. This resulted in gastric inflation and decreased pulmonary compliance and increased inspiratory pressure further, thereby creating a vicious circle. It is therefore recommended that Laryngeal Tube suction (LTS) should be used in all cases of emergency airway management and a gastric drain Tube be inserted through the dedicated second lumen. Apart from gastric overinflation, incorrect LT/LTS placement must be detected and immediately corrected, e.g. in cases of difficult or impossible gastric Tube placement, permanent drainage of air from the gastric Tube, decreasing minute ventilation or an ascending capnography curve.

  • Laryngeal Tube II : alternative airway for children?
    Anaesthesist, 2011
    Co-Authors: R. Schalk, Bertram Scheller, Christian Byhahn, Kai Zacharowski, Norman Peter, Rosskopf W, D Meininger
    Abstract:

    : Difficult airway situations both expected and unexpected, present major challenges to every anesthesiologist, especially in pediatric anesthesia. However, the integration of extraglottic airway devices, such as the Laryngeal mask, into the algorithm of difficult airways has improved the handling of difficult airway situations. A device for establishing a supraglottic airway, the Laryngeal Tube (LT), was introduced in 1999. The LT is an extraglottic airway designed to secure a patent airway during either spontaneous breathing or controlled ventilation. The design of the device has been revised several times and a further development is the LTS II/LTS-D, which provides an additional channel for the insertion of a gastric drain Tube. This article reports on the successful use of the LTS II in 12 children aged from 2 days to 6 years when endotracheal intubation, alternative mask or Laryngeal mask ventilation failed. Use of the LTS II was associated with a high level of success, securing the airway when other techniques had failed. The potential advantage of the LTS II over the standard LT is an additional suction port, which allows gastric Tube placement and can be used as an indirect indicator of correct placement. With a modified insertion technique using an Esmarch manoeuvre, placement was simple and fast to perform. In emergency situations when direct laryngoscopy fails or is too time-consuming the LTS II Tube is recommended as an alternative device to secure the airway. As with all extraglottic airway devices, familiarity and clinical experience with the respective device and the corresponding insertion technique are essential for safe and successful use, especially in emergency situations.

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