Techniques for Management of Diffcult Intubation

B.U.R.P.

This applies to a technique to aid visualization of the larynx when the larynx lies caudal and anterior. It refers to the application :

Backward - to push the larynx backwards

Upward - to push the larynx as superiority as possible

Rightward - no more than 2 cm

Pressure - to the thyroid cartilage (NB. not the Crisco)

LARYNGEAL MASK

This airway is the ideal emergency airway for use by unskilled practitioners. It however does not provide airway protection and therefore in emergency situations should only be seen as a temporary measure. In emergency situations it can be used as an airway in its own right or as a track for the introduction of an airway bogie or, in adults, for the insertion of a size 6 tracheal tube.

TECHNIQUE

Select the appropriate size laryngeal mask
Partially inflate the cuff (this will make insertion easier)
Insert the mask into the pharynx with the distal aperture directed caudally until no resistance to further progression is felt.
Fully inflate the cuff with air (10 ml)
Attempt ventilation
If insertion fails ie if the patient cannot be ventilated, deflate the cuff and withdraw the mask. Re-attempt the procedure with the distal aperture initially directed cranial, then, once in the pharynx, rotate through 180 degrees as for an pharyngeal tube.

If desired, an airway bogie or an tracheal tube may be passed via the lumpen of the laryngeal mask into the trachea. This requires plenty of lubricant and may require a 90 degree rotation of the tracheal tube to manipulate it past the fenestration in the aperture of the laryngeal mask.

COMPLICATIONS