7 thoughts on “Intubation over SGA In Situ ( IOSIS)

  1. Love it!!

    I also love how easy you switch the ventilator tubing from the SGA to the ETT. It just makes sense.

    This idea partly came from my experiments in how to intubate around an insitu Combitube or Laryngeal Tube. I asked myself, “How can I turn what is invariably something that is viewed as negative into something positive?” The answer is to use the concept with an SGA that is easier to perform an endoscopy around, such as an LMA type SGA, and take advantage of the high flow oxygen the SGA can deliver during DL or VL.

  2. Thanks Jim, it felt very smooth, natural and was very rapid with the proper technique. It would be interesting to see how this would work in a cadaver or else if one could get patient’s permission to try DL in elective LMA anaesthesia settings.

  3. I’ll check my files–I think I’ve done it already. The rationale was to train in the process of intubating around the Combitube/Laryngeal tube. This practice came in handy 4 weeks ago when I was requested to intubate a 400 pound lady with an Insitu Combitube in one of our ICUs at 10 pm at night. I handled the situation with a McGrath MAC, which performed well. The key was careful, judicious and systematic suction prior to oropharyngeal balloon deflation, use of the Yankauer as a tongue depressor to allow the McGrath to be positioned quickly and efficiently, further cleaning of the supralaryngeal space with the Yankauer, and insertion of the tracheal tube without touching anything gross still in the pharynx.

    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.

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