I have successfully used this technique with propofol infusion and 100% FIO2 ventilation (in lieu of the inhalation anesthesia technique), so this is workable. The addition of ketamine to the propofol makes it even easier, but you still need topical local anesthetic. Administering the local anesthetic through the mask itself is very effective.

See http://nswhems.files.wordpress.com/2011/09/c-18-advanced-airway.pdf for our options

The technique shouldn’t be necessary with an aScope 3 which will fil an Aintree
http://www.ambu.com/visualisation/ascope_system/ambu_ascope_3_slim.aspx

Cliff

I hear there is a new one that goes through an Aintree…bougie, then Scope/ETT

Need to practice on elective lists to keep hand in. Prob not good for soiled airway…but for the obese/predicted diff airway who needs intubation for transfer, this combo is very useful

as for iGel…I reckon you could do it but it would be a tight fit and you would need a smaller ETT. Cliff’s way you can exchange for a larger ETT I imagine and its smoother ETT passage.

Can;t see why need to, but I must be missing something obvious here – why are you cutting it?

Got the Ambu guys coming over to KI later in year, as they do both the disposable scope and the KingVision now…can;t wait to pull ut my trauma shears and cut their demo model

I;ll blame it on Cliff….

The pitfall that Minh points out can be obviated by placing the scope REAL DEEP, and then cutting the tracheal tube at 26-28 cm (reducing its length and dead space).

The simulation I performed was for my own curiosity, and of course, so I could “re-run the tape” and get that instant replay. That’s how I learn best.

I imagine Jim did not have an iGel available or was just wanting to test if similar technique worked via a LMA SUpreme.

RFDS QLD carries the LMA Supreme and Fastrach ILMA so its nice to know that if we added an Ambu Ascope we have that option of tubing with it even via the Supreme.

its true that one potential pitfall of this technique using a SGA that you have to remove to railroad the ETT, is dislodging the scope shaft from the trachea and now you cant reuse it as you have just cut it!

Why not iGel – AmbuAscope with ETT preloaded – then intubate thro iGel?

Or AirQII?

Saves cutting the bronchoscope and risk of misplacement as remove LMA/place ETT

I’m following Minh, and just letting you know I am waiting on a time with Monash to schedule a meeting to draft/scope a IN ketamine trial. Now that I will have information from Slade, this meeting can take place.

Cheers
PC

Paul Centofanti
National Clinical Support and Development Manager

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MK

One of my favorite things is that you can do everything (suction, ELM, intubate with bougie, deliver tube, inflate cuff), you don’t lose your syringe/ bougie because it is held and it maintains its shape and configuration on a DumpKit/prep table to allow very rapid pickup with one hand.

Harold

What I love about this is that you are independent especially if you have limited assistance in PHARM or rural settings. It is also very sleek and fast.

The d-grip with murphy eye lock on the bougie end allows it to be shaped and kept on a dumpkit/table and easily picked up with the syringe in one hand (think “91″ on the setup and the syringe points up like a rocket). You can easily and efficiently pick up the yankauer and suction, replace it, and move to ELM and bougie intubation followed by unlocking the bougie proximal tip from the murphy eye and then railroading and inflating the cuff. All with the one hand, no assistant. Jim also mentioned you can also use your right hand to do other things too during laryngoscopy like apply distracting forces on the right upper eye teeth behind the canines for better laryngeal exposure. This is not something I have done before but will try it in the sim lab. I am also itching to try paleo too.

Back to d-grips:

I also worried about damage to the murphy’s eye but it does not seem to cause a problem if one is careful about disengaging it. Locking the ETT/bougie on the laryngoscope-holding-hand’s thumb allows you to pull the bougie end tip out of the murphy’s eye very easily. I am uploading a vid to vimeo that will detail that (using my homemade intubation model of a wine glass and an upside down remote control device).

Other issues is holding the ETT, a lubed tip/balloon and contaminating the tip of the bougie when grabbing for the ELM or suction … if you are careful how you hold it, the tip can be kept free in the air. The ETT can also be held proximal to the cuff to avoid lube goobing up your fingers making things slippery (when pulling the bougie tip out of the murphy’s eye however is best by putting your fingers down to ETT tip). As for sterility of the ETT tip, sterile gloves solves that issue but securing airway first is key of course.

I’ll be doing more tests in the sim lab and upload vids. Love for others to try it, test it, upload vids of it and share their experiences.

Thanks a million to Jim for the inspiration! The collaboration on developing this idea has been amazing between all of #FOAMed #SoMe: Tim Leeuwenburg saw my sim demo and suggested Kiwi grip. I did another vid on it and Jim saw it and played with it. He shared with me and then Jim, Minh and I chatted it up and examined it over 1-2 days and here we are now!

http://lifeinthefastlane.com/2010/12/jesus-saves/

I’m going to see if I can get a trial for the RFDS WA.

I’m happy to help out and have got a fair bit of info and IP about pre-hospital systems. If either of you’d like to contact me directly I’m happy to discuss.

Thanks

James

That patient was transported to that ICU with the Combitube as the main airway from a hospital over 40 miles away–apparently, they could not intubate her at the other institution.

This case shows the value of simulation PRIOR to the event. I did not need to make it up as I went along.

Interesting trivia – Sir Robert Reynolds Macintosh was the first Professor of Anaesthesia outside of the US (Oxford) and was also the inventor of the elastic gum bougie (he used a urinary catheter initially)

Not bad for a bloke from …. Timaru.