Genesis Airway Innovations

INTUBATION RELATED TRAUMA

shadowsafe — Thu, 05 Aug 2021 18:47:00 +0000

The reason why you should use Genesis ETTs with posterior facing bevels and atraumatic tips.

Genesis Airway thanks Airway On Demand for allowing us to use this instructional video

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SECURE A NASAL AIRWAY SAFELY

shadowsafe — Thu, 05 Aug 2021 18:43:40 +0000

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HANG UP ON LARYNGEAL STRUCTURES WHILE ATTEMPTING INTUBATION

shadowsafe — Thu, 05 Aug 2021 18:35:22 +0000

Genesis Airway thanks Airway On Demand for allowing us to use this instructional video demonstrating hang up on laryngeal structures whilst using an ETT with a lateral facing bevel – relieved by rotating the ETT 90° so that the bevel is posterior facing.

The importance of first pass intubation is paramount for any intubation, but vital for unplanned emergency surgery and patients with difficult airways. For this reason, all Genesis products have posterior facing bevels with curved atraumatic tips ensuring the ETT is centred on the FOB or bougie.

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IMPORTANCE OF FIRST PASS INTUBATION OUT OF OPERATING THEATRES

shadowsafe — Fri, 16 Aug 2019 00:51:11 +0000

These intubations are performed on often critically ill patients who have an additional aspiration risk.

J.C. Sakles et al. 44 studied over a 4-year period 1,828 orotracheal intubations in emergency departments

Adverse Events (AEs) included aspiration, oxygen desaturation, oesophageal intubation, hypotension, dysrhythmia, and cardiac arrest

Intubation successful	incidence of one or more AEs
first attempt	14.2%
requiring 2 attempts	47.2%
requiring 3 attempts	63.6%
requiring 4 or more attempts	70.6%

CONCLUSIONS:
When performing orotracheal intubation in the ED, first pass success is associated with a relatively small incidence of AEs. As the number of attempts increases, the incidence of AEs increases substantially.

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Historical Use of Nasal laryngeal Masks

shadowsafe — Wed, 29 May 2019 22:25:36 +0000

Archie Brain is a British anaesthetist best known as the inventor of the laryngeal mask in 1981. The laryngeal mask airway has since been used over 300 million times worldwide in elective anaesthesia and emergency airway management.

1997
Marchionni,L. MD ;Agro, F. MD et al 43. described a simple retrograde technique using a Foley catheter and a flexible laryngeal mask that was used in five patients. One patient had minor epistaxis, but there were no other complications.

2007
Arisaka H, Matsumoto M, et al 48 from Japan modified Marchionni’s method by using a nasogastric tube taped into the laryngeal mask airway tubing instead of a Foley catheter. It was used in fifteen patients undergoing dental procedures . There was no significant bleeding from the intubated nostril in any of the patients. None of the patients complained of sore throat, coughing, hoarseness, or any discomfort in the nose.

2007
Researchers from the Osaka Dental University in Japan published an article 49 concluding that the flexible laryngeal mask could be safely used as a nasal airway for minor oral surgery and the insertion and removal techniques using a Foley catheter were simple, and atraumatic and safely applicable.

These improvised Nasal Laryngeal Mask Airways have been used safely in over 20 patients.

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WHICH NOSTRIL TO INTUBATE?

shadowsafe — Wed, 29 May 2019 22:19:04 +0000

Standard endotracheal tubes have flat left facing bevels with the tip on the right side. The turbinates are theoretically more at risk from damage when passing an endotracheal tube through the right nostril, and the septum with the left nostril . Studies have compared the rates of epistaxis during intubation and extubation, and found that the choice of nostril side made no significant difference to trauma caused.15, 35

Lim and colleagues concluded that the selection of the nostril with higher nasal flow rate (FEV(1) and FEV(1)/FVC )was associated with less epistaxis(P<0.05) and easier passage of the tube (P<0.05).35

In an attempt to successfully select the more patent nostril, Smith and Reid 31 used fiberoptic laryngoscopy to study the nostril anatomy of 60 oral surgery patients with no symptoms or signs of nasal obstruction. They found 68% had intranasal abnormalities (of which 10% were bilateral) and resulted in one nostril being more patent than the other.31 From these results, they suggested that anesthetists should consider using the fiberoptic laryngoscope to select the best nostril for nasotracheal intubation.31

All Genesis Airways use Endotracheal tubes with posterior facing bevels and introducers enabling the most patent nostril to be chosen.

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COMPLICATIONS ARISING FROM THE BLIND PASSAGE OF AN ENDOTRACHEAL TUBE THROUGH THE NASOPHARYNX INCLUDE

shadowsafe — Wed, 29 May 2019 22:13:55 +0000

-EPISTAXIS

Epistaxis rate of 86% reported with nasal endotracheal intubation.16

-NASAL AND NASOPHARYNGEAL SOFT TISSUE MUCOSAL DAMAGE 3,4

-AVULSION OF A TURBINATE 5,6,7

– RETROPHARYNGEAL DISSECTION 10,48

– OBSTRUCTION OF ENDOTRACHEAL TUBE WITH AVULSED TISSUE. 7, 8, 9

– POST INTUBATION NASAL PAIN.

– AUTONOMIC HYPERTENSIVE AND TACHYCARDIC RESPONSE TO NASAL INTUBATION.

– INRACRANIAL PLACEMENT OF NASOTRACHEAL TUBE. 11, 12

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THE NASAL CYCLE

shadowsafe — Wed, 29 May 2019 22:10:44 +0000

German physician Richard Kayser first described the nasal cycle in 1895. He observed the alternate congestion and decongestion of blood-filled erectile tissue in the nasal turbinates. The duration of this cycle ranges from 40 minutes to several hours in normal nasal passages and allows the human to physiologically have two noses. The nasal cycle is controlled by the autonomic nervous system. There are several reasons postulated for the existence of the nasal cycle. Switching of airflow between nostrils prevents excessive drying, crusting and infection that would occur if the airflow were static. The switching mechanism and engorgement of the erectile tissue operates as a periodic pump to generate plasma exudate important for respiratory defense mechanisms. Scent molecules degrade and are absorbed at different rates allowing easier detection of some smells in the fast moving airflow and others in the slower airflow. It was observed that in the lying position the dependent nasal fossa was engorged and it is postulated that this causes the person to alternate sides when sleeping.

A good reason in choosing the most patent nostril at the time of intubation!

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STUDIES SUPPORTING GENESIS INNOVATIONS

shadowsafe — Tue, 21 May 2019 09:30:52 +0000

a. Studies showing increased safety of using catheter/introducer guidance for nasotracheal intubation.
22,23,24,16,41
b. Studies showing increasing external diameter of the tube passing through the nasopharynx airway increases complications.
2,4,15
c. Study to show safety of reinforced tube in nasal endo- tracheal intubation compared to PVC tubing.
25
d. Study to show difficult passage through nasopharynx increases complications.
13
e. Study to show endotracheal tubes with posterior facing bevels are safer to pass through the nasopharynx.
20
f. Studies to show intubation of the lower nasal pathway is safest.
25,26,27
g. Study to show the benefit of securing and maintaining an airway before nasal endotracheal intubation and potential complications.
37
h. Studies to show that most patent nostril should be selected for intubation.
31,33,35
i, Studies to show ease of placement of reinforced tube with posterior facing bevel into the trachea.
39,40
j. Studies showing the complications of nasal endotracheal intubation.
1,12
k. Study to show advantages of laryngeal mask use compared to endotracheal tubes.
38
l. Study to show nasotracheal intubation provides a more secure airway that orotracheal intubation.
42
m. Studies demonstrating the clinical use of nasal laryngeal masks in patients has been safe.
50, 48, 49
n. Studies demonstrating the need for an interchangeable oral/nasal endotracheal tube.
46, 47
o. Study demonstrating the clinical use of interchangeable oral/nasal endotracheal tube has been safe.
43
p. Study to show reduced subglottic airway injury when using a GlideScope and endotracheal tube with a posterior facing bevel.
51
q. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department.
44
r. Most standard endotracheal tubes (ETT) are too short to guarantee tracheal intubation when intubating through a laryngeal mask airway.
52
s. Blind intubation through a laryngeal mask airway .
53, 54
t. Comparison of efficacy of different endotracheal tubes used to intubate through a laryngeal mask airway .
55, 56, 59
u. Fibre optic assisted intubation through a laryngeal mask airway .
57, 58
v. Laryngeal mask airway – comparative study.
60

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