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rogerabn · 03-22-2004, 19:23

First time posting but this is my area of expertise. So I am going to wade in here with my personel feelings about the above kit.
Overall a nice kit, but I feel lacking some important airway adjutants. For example:

1 A 10 cm oral airway. Frequently I have found I was unable to adequately move air with an improper sized airway. Most adult males need a 10cm length to adequately open their airway.

2. McGill forceps, these are indispensable for removing visualized obstructions in the upper airway, and are also indispensable for picking up the end of the ET tube to guide between the cords when preforming a nasal intubation.

3. I intubate 90% of my patients with a Miller 2 blade, possibly the most used by all the anesthesia practioners that I have come in contact with. I only go to larger blade when the patient has a obvious long neck. With difficult airways, ( small mouth, short neck, anterior displacement, large tongue) I use a Macintosh 4 so I will have as much room for passing the tube as possible. With a straight blade I have had several instances where I had good visualization of the cords but could not pass the tube due to the blade physically being in the way.

4.An intubating stylet. Not only the type that you use routinely in the ET tube, but a long flexible stylet for difficult airway algorthynms. They have save my ass more than I care to remember. I always use a stylet (sissy stick) for intubation. The risks are way to high to be writing checks on your patients life that you may not be able to cover.

5. I noted that there was one of the most important items missing, and that is the ambu-bag with proper sized mask. All the high speed equipment in the world can not replace good airway management technique. Proper flexing of the neck to open the airway, proper size and placement of an oral airway. Good tight mask seal with your ambu-bag. These are what you will need to provide before you even put a blade on a handle.

6.It all comes down to the abcâ€™s, and with out securing a good airway there is not much one can do for a patient except watch him or her suffocate

Roger Coleman,CRNA,MS.

03-22-2004, 19:23	#8
rogerabn Asset Join Date: Feb 2004 Location: Dallas TX Posts: 16	First time posting but this is my area of expertise. So I am going to wade in here with my personel feelings about the above kit. Overall a nice kit, but I feel lacking some important airway adjutants. For example: 1 A 10 cm oral airway. Frequently I have found I was unable to adequately move air with an improper sized airway. Most adult males need a 10cm length to adequately open their airway. 2. McGill forceps, these are indispensable for removing visualized obstructions in the upper airway, and are also indispensable for picking up the end of the ET tube to guide between the cords when preforming a nasal intubation. 3. I intubate 90% of my patients with a Miller 2 blade, possibly the most used by all the anesthesia practioners that I have come in contact with. I only go to larger blade when the patient has a obvious long neck. With difficult airways, ( small mouth, short neck, anterior displacement, large tongue) I use a Macintosh 4 so I will have as much room for passing the tube as possible. With a straight blade I have had several instances where I had good visualization of the cords but could not pass the tube due to the blade physically being in the way. 4.An intubating stylet. Not only the type that you use routinely in the ET tube, but a long flexible stylet for difficult airway algorthynms. They have save my ass more than I care to remember. I always use a stylet (sissy stick) for intubation. The risks are way to high to be writing checks on your patients life that you may not be able to cover. 5. I noted that there was one of the most important items missing, and that is the ambu-bag with proper sized mask. All the high speed equipment in the world can not replace good airway management technique. Proper flexing of the neck to open the airway, proper size and placement of an oral airway. Good tight mask seal with your ambu-bag. These are what you will need to provide before you even put a blade on a handle. 6.It all comes down to the abcâ€™s, and with out securing a good airway there is not much one can do for a patient except watch him or her suffocate Roger Coleman,CRNA,MS.
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