Laryngoscopes are used to perform direct laryngoscopy andsupport in tracheal intubation Al-Shaikh&Stacey (2013). A laryngoscope comes with a small cuff at thefar end for inflation into the trachea E.Martin (2015). The blades can becurved or straight depending on the patient.
The Macintosh blade is mostly usedover the curved blade, miller being the common straight style blade being used. Both blades are available in sizes 0 to4 the Al-Shaikh (2013). Laryngoscopesare located into the right side of the mouth making sure the tongue is swept tothe left.
The laryngeal inlet can be viewed by the tip of the blade beinginserted into the vallecula lifting the epiglottis J.Shorthouse (2017). Nasopharyngeal is a device to uphold a patients airway torelieve upper airway obstruction. It is flexible and curved with a wide end tostop loss within the nostril J.
Shorthouse (2017). The sizes vary, in order togain the correct size measuring the patients nostril to the angle of their jawneeds to be done J.Shorthouse (2017). Before inserting, lubrication is applied andthe airway is inserted through the nose into the nasopharynx to avoid thetongue from obstructing the posterior oropharynx J.Shorthouse (2017). A guedel is an oropharyngeal airway piece which is used touphold a patients airway by avoiding the tongue covering the epiglottisR.
Ireland (2010). A guedel comes in different sizes from new-born to adults, asize 4 which is for a large adult, a size 3 for medium adults, size 2 for smalladult and a size 1 and under for a child R.Ireland (2010).
A guedel is introducedinto the mouth upside down and is then rotated 180° in adults with thewide part resting firmly against the oral introductory. For infants, it is introducedthe right way up with the tongue held forward using a tongue depressorR.Ireland (2010). Laryngeal masks support by keeping a patients airway openedduring anaesthesia or unconsciousness. The average size for adult females is 3and adult males are mainly 4 or 5 E.Martin (2015).
A laryngeal mask has anairway tube with an oval inflatable cuff at one end for insertion into themouth E.Martin (2015). The laryngealmask sits in the hypopharynx at the crossing point amongst the gastrointestinaland respiratory tracts which is where it produces a low compression closurearound the glottis J.Brimacombe (2008). Endotracheal tubes are used to protect a patients airwayand can be used for both oral or nasal, they differ in sizes for adult males it’s8.
5-9mm and for adult females is 7.5-8mm. For paediatric patients the sizesdiffer depending on the age and weight Al-Shaikh (2013). Endotracheal tubes arecuffed and uncuffed, air tight seal is present when the cuff is inflated betweenthe tube and tracheal wall. A pilot balloon exists which specifies if the cuffhas been inflated or not Al-Shaikh (2013).
The tube is put into the trachea it’sshown whether it has been placed in the correct position or not by ensuring thevocal cords are at the black mark in tubes with one mark or should be amongstmarks if there are two such marks Al-Shaikh (2013). Ensuring airway equipment is available with a full range workingwith spares. These include endotracheal tubes, laryngeal masks, guedel,nasopharyngeal airways, laryngoscope, catheter mounts, intubation forceps and bougiesHartle (2012). Equipment may be needed for the management of any unforeseendifficult airway which should be available and checked. A record needs to bemade of who checked the anaesthetic machine by signing and dating the logbookto confirm it has been checked Hartle (2012). to a test lung or bag , ensuring the reservoir bags has noleaks.
Blocking off the patient end and squeezing the reservoir bag should bedone by performing a pressure leak amongst 20-60 cmH2O on the breathing systemHartle (2012). Vaporisers need to be filled and each need to be accuratelyseated on the back bar making sure it’s not slanting and checking for any leaksby temporarily blocking the common gas outlet Hartle (2012). All vaporises needto be turned off repeating the test instantly after altering any vaporiser. Ventilatorsalso need to be checked ensuring the tubing is firmly attached and the controlsshould be set for use, confirming an acceptable pressure is being produced duringthe inspiratory phase. Disconnection of alarms need to function. Alternativesto ventilate the patients lungs need to be available so a self-inflating bagand an oxygen cylinder ensuring both are functioning and the cylinder consistsof a suitable supply of oxygen Hartle (2012). The scavenging system also needs tofunction which is done by attaching the tubing to the appropriate exhaust portof the breathing system Hartle (2012).
The two bag test is done by attaching the patient end ofthe breathing system Theprimary check on the anaesthetic machine involvesensuring a workstation and applicable ancillary equipment are connected to themain electrical supply and all are turned on. Extension leads which aremulti-socket shouldn’t be plugged or used to connect the anaesthetic machine tothe mains supply and backup batteries should be available and charged Hartle(2012). The next check is a ‘tug test’ where the pipeline hoses are plugged inindividually and cylinders are filled and turned off, ensuring the machine isconnected to a source of oxygen and a suitable supply of oxygen is availablefrom the oxygen cylinder the accurate pipeline gauge should indicate about 400kPa Hartle (2012).
Each valve on the flowmeters should activate smoothly andeach bobbin should be moving easily without sticking to the gauge. Checking theanti-hypoxia device is working accurately is another check where the nitrousoxide rotameter is turned anticlockwise in a precise way until the bobbinreaches the top of the flow tube, if the link 25 safety system is workingprecisely the oxygen flow should have also triggered making sure that there isat least 25% mixture of the gases Hartle (2012) . Checking the oxygen flush isworking is done by pressing the flush button on the machine. Checking suctionis also a vital part and is done by making sure all the connections are secure andtesting for fast progress of an adequate negative pressure Hartle (2012).
The policies on examination of the anaesthetic equipmenthave been issued by the Association of Anaesthetists of Great Britain andIreland (AAGBI). According to these guidelines checking the anaesthetic equipmentis the most vital part to safe patient care A.Hartle, E.Anderson, V.Bythell,L.Gemmell, H.Jones, D.Mclvor, A.Pattinson, P.Sim and I.Walker (2012).