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.

Rigid Intubation Scopes

Rigid endoscopes are very valuable tools for intubation in certain difficult scenarios, but are not commonly used in most centres.  The techniques and learning curve differ significantly from normal direct laryngoscopy, requiring independent practice to become proficient.  Pictured here are (left to right) a rigid bronchoscope, Bonfils, Levitan and Shikani optical stylets (rigid intubating endoscopes).

(L to R) Rigid bronchoscope, Bonfils, Levitan and Shikani optical stylets.  Click to enlarge.
(L to R) Rigid bronchoscope, Bonfils, Levitan and Shikani optical stylets. Click to enlarge.

This is the set-up for basic training on an UCT Anaesthesia Airways course.  Which of these devices have you used?  Do you have tricks or comments to share?

Difficult Airway Society Algorithm App

Good suggestion out of the Twittersphere from @Sub_Effect – the Difficult Airway Society (DAS) has a smartphone app available for both iOS and Android which allows you to work through the various algorithms at the click of a thumb.  iDAS includes the following algorithms:

  • RSI Failed Intubation
  • CICV
  • Routine Failed Intubation
  • Overview of Guidelines

iDS

Best bit?  It’s free!

Paediatric Bonfils Intubation

Intubation in a young child with a severe submandibular abscess using the paediatric Bonfils rigid intubating endoscope under inhalational general anaesthesia. Direct laryngoscopy showed only severe swelling with a Cormack-Lehane grade 3b view.  A standard laryngoscope was used with the left hand to create an open path for the Bonfils just right of the midline, avoiding the worst of the submandibular swelling.  3.5mm Bonfils allowed intubation with a 4.5 mm uncuffed ETT.  Note that because this is a rigid intubating scope, it is not inserted through the vocal cords, but they are visible through the tube as it is inserted with the Bonfils held steady.

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