Technique for using the Aintree Intubating Catheter (AIC) to exchange between a supraglottic airway (SGA) and endotracheal tube (ETT). This is typically required when an airway has been ‘rescued’ with an SGA that is not designed for direct intubation, with a narrow internal diameter or obstructions. The Aintree has a length of 55cm, internal diameter of 4.8 mm (not 4.2 as stated in the video) and external diameter of 6.0 mm, allowing a paediatric fibrescope or flexible intubating vide endoscope (preferably 4 mm or less) to be passed through the AIC, into the trachea, and then an ETT railroaded after removal of the SGA over the AIC. If that sounds confusing, watch the video!
Tips/tricks/advice/critique? Leave a comment!
The Difficult Airway Society (DAS) have a nice poster guide to help you remember how to do this – click the image below to open/download. (Open access).
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.
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.
Open access meducation for all aspects of airway management