Ch. 10: Supraglottic Extraglottic Devices

Question 1

Terminology

Answer 1

• Devices that sit on top of larynx are supraglottic.
• Those blindly inserted into esophagus are retroglottic.
• SGD 1st generation have no esophageal portion. Second generation have a gastric drainage tube.

Question 2

SGD Indications

Answer 2

• BVM can be impossible in some patients.
• Intubation also can fail.
• SGD bridges the gap.
• Can be used while preparing for cricothyroidotomy
• Can be used to facilitate ETT.

Question 3

The devices

Answer 3

• LMA unique-Disposable classes
• LMA flexible. Reinforced tube
• LMA ProSeal
• LMA Supreme
• Fastrach intubating LMA. ILMA

Question 4

Inserting a NonIntubating LMA

Answer 4

• Size 4 50 to 70kg. Size 5 over 70kg
• Inflate then deflate while pressing on table.
• Lubricate front and back.
• Open side towards tongue as far in as possible. THEN use other hand pressing the tube in as far as it will go.
• Inflate 30cc no 4 or 40cc no 5.

Question 5

Inserting LMA Fastrach

Answer 5

• Size 3, 4 or 5. 3 is 10 to 12 yo pt.
• Deflate and lubricate mask and stem.
• Make sure tip is flat (not folded) against palate
• Rotate it in to place.
• Insert well lubricated ETT w black line facing you.
• Keep going until transverse line (about to enter).
• Lift LMA as if intubating while advancing the ETT.
• Inflate ETT cuff.
• Deflate LMA cuff. Remove 15 mm ETT connector.
• IMPORTANT. HOLD ETT while removing LMA until the two are aligned. THEN use stabilizer bar to keep ETT in place while you pull LMA out more.
• THEN!! Remove the stabilizer bar to allow ETT Pilot baloon room to pass through the LMA.