Category Archives: AirwayHowTo

Video: Overview of intubating through SGAs

Yip, another whirlwid tour, this time of the situations and considerations that may lead to intubating through a supraglottic airway.  Each method will be expanded upon in later videos.

These videos are made off-the-cuff and can certainly be improved, so if you have suggestions, please put them in the comments!

Video: Using supraglottic airways

A whirlwind tour through selection, indications, precautions, sizing and troubleshooting.  For an overview of the types and classifications, see this post.

These videos are all unscripted, so if you have suggestions for improvement, please leave a comment below!

Cannula Cricothyroidotomy

In response to a great Twitter discussion with PHARM‘s @ketaminh:

See Minh le Cong’s PHARM blog post, video and podcast here.  Please note that using a BVM is not the advised technique of oxygenation, but is used here because we don’t have an oxygen source in the skills lab.

Lots of ensuing discussion of the ideal angle of puncture of the cricothyroid membrane.  90 degrees (perpendicular to skin) has least risk of puncturing posterior wall of the trachea, but greatest risk of cannula kinking.  I advocate around 60 degrees for puncture and then decreasing angle to advance cannula:

Why is my C-MAC Pocket Monitor not working (again)?

Despite making a previous post and video to explain the way to make sure the device switches on, I regularly get told that the Pocket Monitor (PM) for our C-MAC video laryngoscope is not working/charging/switching on. This is in fact a design feature to prevent accidental activation or discharge. Watch here to find out more:

Thanks to the lovely Sam Adams for playing along…good career in acting if anaesthesia were to ever become boring!

C-MAC PM not turning on?

Folks are frequently reporting that our C-MAC Pocket Monitor is not switching on when they plug it in to a blade and want to use it, without realizing that it automatically goes into a hibernation mode if left in the open position for more than 15 minutes. Check out this quick AirwayHowTo video on solving this problem:

Quick Tip: IntraOp Temperature Monitoring with a 2nd generation SGA

Without getting into a lengthy argument about what constitutes a second-generation supraglottic airway (or an extraglottic vs. supraglottic, for that matter), if you are using an SGA with a gastric drainage port (such as the LMA Proseal, LMA Supreme, i-Gel, etc) you have a very simple and easy conduit to insert a mid-oesophageal thermistor probe to monitor patient temperature.

Mid-oesophageal temperature probe inserted via the gastric drainage tube of an LMA Supreme
Mid-oesophageal temperature probe inserted via the gastric drainage tube of an LMA Supreme

Ideally, to achieve a mid-oesophageal position, you need the probe to extend 5-10 cm past the tip of the SGA, so try and remember to measure the probe against the device before insertion and mark it with a small piece of dressing tape.  This has an added advantage of helping prevent air leak via the drainage tube if your SGA is not seated or strapped ideally.   Of course, this means that drainage via the oespophageal lumen is significantly impaired, and you cannot insert a gastric tube without removing the probe first, so it is only suited to patients in whom you have little concern regarding reflux and aspiration.  Devices that offer twin drainage tubes (such as the 3gLM) are a way around this problem.