Anesthesiology instruments

1. Airway equipment
To ensure the patient has a patent airway Prevent the tongue from falling back and hence blocking the airway

Oropharyngeal airway

Known as Guedel airway Curved plastic tubes Lie over the tongue preventing it from falling back into the pharynx Common sizes 2-4 Estimated by comparing the airway length with the vertical distance between the patient's incisor teeth and the angle of the jaw.

Nasopharyngeal airway

Round malleable plastic tube Beveled at the pharyngeal end Flanged at the nasal end Lie along the floor of the nose Curve round into the pharynx Common sizes : 6-8mm diameter Estimated by comparing the airway length with the vertical distance between the patient's anterior nares of the nose to the tragus of the ear.

Laryngeal Mask Airway (LMA)

Sits over the laryngeal opening Attached to a tube that protrudes from the mouth Connects directly to the anesthetic breathing system Inflatable cuff to stabalise and create a seal Common sizes are 3-5 Designed for spontaneously breathing patients It is also possible to ventilate patients with the LMA

LMA fastrach

Modified laryngeal mask specifically Designed to allow tracheal intubation while maintaining ventilation in patients with either normal or abnormal airways. The chief features of the design are an anatomically curved, rigid, metallic conduit with an integral handle, an epiglottic elevating bar, and a guiding ramp designed to direct an endotracheal tube anteriorly into the glottis as it exits from the device

Proseal LMA
Supraglottic airway device Additional posterior cuff to improve the seal between the mask and the larynx Incorporates a gastric drainage tube placed lateral to the main airway tube and which ends at the tip of the mask Ryles tube can be inserted to aspirate gastric contents

Tracheal tubes

Endotracheal tube, cuffed

Tracheostomy tube, cuffed

A catheter inserted into the airway For the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide 2 different types : ETT and tracheostomy tube

Standard PVC

Preformed tube : Used during surgery of head and neck Designed to take the connections away from the surgical field.

Ring-Adair-Elwin (RAE) tube

Allows the endotracheal tube, once placed, to be angled away from the face to facilitate access during surgeries around the head and neck

Double lumen : 2 tubes effectively wielded side by side One tube extending distally beyond the other Used during thoracic surgery allowing one lung to be deflated whilst ventilation is maintained via the bronchial portion of the opposite lung.

Reinforced tube : Prevent kinking and subsequent obstruction When positioning the patients head

Laryngoscope
Light at the tip Handle that contains batteries

Curved blade McCoys blade

Enable direct visualization of the larynx To facilitate the insertion of the tracheal tube

Gum elastic bougie

60 cm long malleable introducer Adjunct for difficult endotracheal intubation Flexible but has some shape retention Slightly angled tip

Indication: For directional control during routine or difficult endotracheal intubation when the laryngeal inlet cannot be completely seen.
Precaution: Excessive force, passage beyond the carina, or blind introduction may result in soft tissue damage or may cause rupture of the bronchus.

2. Facemasks

3. Anesthetic gases

Oxygen

Gas cylinder has :

white shoulder ; black body

Nitrous oxide

Gas cylinder has :

blue shoulder ; blue body

Medical air

Air is supplied to the operating theatre at : - 400kPa for anesthetic use - 700kPa to power medical tools Air cylinder has : white/black shoulder ; grey body

Vacuum

3. The anesthetic machine

Flow meter
Main functions are : -Reduce the high pressure gases from either pipeline or cylinder
-Control the flow of gases allowing a known and adjustable composition to be delivered into the anesthetic breathing system

The needle valve controls the flow through a flow meter

Anesthetic breathing circuit

Gases from the anesthetic machine

Mixture of anesthetic gases and vapour

Anesthetic circuit

Face mask/ Laryngeal mask/ Tracheal tube

Patients lungs

Circle breathing system

(Soda lime)

Components for a breathing system: -Connection for fresh gas input -Reservoir bag -Adjustable expiratory valve