Modern Airway Management

Transcription

1 AN /2016-E Modern Airway Management with the C-MAC System in Bariatric Surgery

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3 Do adipose patients present a weighty problem? Obesity, defined as an independent disease in 2000 by the WHO, has almost doubled worldwide since According to WHO reports, more than 1.4 billion adults over 20 years of age were considered to be obese in 2008 and it is likely that the number of obese patients will continue to rise. 1 A high grade of adiposity is considered to be a good predictor for difficult intubation. Among other factors, the special positioning required for obese patients presents a particular challenge for airway management. KARL STORZ offers customized solutions for modern airway management in bariatric surgery. 1 cf. WHO website, in: (July 2013) 3

4 No airway in sight? Bariatric surgery is adapted to the particular features of adipose patients only intubation is performed in a conventional manner. This dispenses with a decisive opportunity to minimize risks. Who would buy a car without an airbag? Due to their weight, adipose patients feature anatomical characteristics that can lead to complications in intubation: Reduced neck mobility Short neck, allowing little or no reclination Small mouth opening Large chest circumference (especially in women) Large tongue Additional tissue folds reduce the oropharyngeal space Reduced lung volume High proportion of adipose tissue often prevents manipulation of the glottis. Visualization of the larynx is often inadequate or even impossible as the anatomical conditions make laryngoscopy difficult. Mallampati IV Cormack & Lehane III/IV Fig.1: Mallampati and C&L classification of an adipose patient (Source: Archive PD Dr. Noppens, PD Dr. Piepho) Awake fiberoptic intubation remains the gold standard in the expected difficult airway. The use of video laryngoscopes such as the C-MAC or the C-MAC PM video laryngoscope from KARL STORZ has led to a significant decrease in such awake intubations and has greatly enhanced patient safety. A study by KAPLAN MB et al showed that, in 84% of cases where the glottis was not visible, video laryngoscopy greatly improved the view of the glottis when compared to direct laryngoscopy 2. In a further study, BYHAHN C et al came to the conclusion that the use of KARL STORZ video laryngoscopes enhanced visualization in expected difficult intubation. 3 2 KAPLAN MB et al. Comparison of direct and video-assisted views of the larynx during routine intubation. Journal of clinical anaesthesia Aug; 18(5): BYHAHN C et al. Tracheal intubation using the mobile C-MAC video laryngoscope or direct laryngoscopy for patients with a simulated difficult airway. Minerva anaesthesiologica Aug; 76(8):

5 Easy intubation even in the case of particular positioning Fig. 2: Lateral positioning of an adipose patient (Source: Archive Prof. Dr. Byhahn) Look around the corner With the C-MAC video laryngoscope, intubation of patients in a lateral position is much easier than with a conventional laryngoscope. As the camera (CMOS chip) is located at the distal tip of the blade, a direct line of sight between the eyes and the glottis is not required. Fig. 3: Video laryngoscopy allows, in contrast to conventional laryngoscopy, a "look around the corner" (light blue area with D-BLADE) 3Ts* Essential for Secure Video Laryngoscopy TIP: Visualized blade tip for improved orientation TARGET: Improved viewing of the target structure (glottis) TUBE: Insertion of the tube possible without guiding stylet (MACINTOSH blade) * Preconditions for secure video laryngoscopy are that the Tip, Target, and Tube can be identified on the monitor. 5

6 Airway management from KARL STORZ offers you the ideal solution to meet specific challenges in bariatric surgery. Stand-alone Video Laryngoscope C-MAC PM - 3.5" OTI display with wide viewing angle of High-contrast images, even in bright daylight; absolutely waterproof (IPX 8) - Real-time documentation for quality assurance via BlueButton - Exchangeable and rechargeable battery pack uninterrupted readiness - The new C-MAC PM connecting cable (8403 XDP) enables optimal visualization, also in patients with a difficult anatomy - Meets the stringent demands of emergency medicine (DO-160 F) - Universal C-MAC system interface, tailored to your airway management C-MAC MACINTOSH - Standard MACINTOSH shape - For teaching and training as well as difficult airway management - Can be used on both anesthetized and awake patients D-BLADE: - For the difficult airway - Low profile - Can be used on both anesthetized and awake patients 6

7 C-MAC Intubation System FIVE - Convenient 4:3 image format with excellent image quality - Immediate changeover to the video laryngoscope possible - For awake and anesthetized patients C-MAC Monitor BONFILS - Ideal for a minimal mouth opening and restricted reclination - For anesthetized patients 7

8 C-MAC Video Laryngoscope In the case of difficult airway conditions, the epiglottis can be elevated with the long MACINTOSH blade #4 using the MILLER technique to provide a better view of the larynx. With its flat profile and elliptically tapered blade shape, the D-BLADE can be glided along the tongue to guide the user directly to the epiglottis. Particularly when it comes to anatomically difficult patients (C&L III and IV), the D-BLADE enables successful intubation. With a low blade height of only 12 mm, it can also be used for patients with a minimal mouth opening. The C-MAC video laryngoscope can also be used to intubate anesthetized patients and, if necessary, awake patients ZX 8403 X 8403 ZXK C-MAC Monitor for CMOS Endoscopes, screen size 7" with 1280 x 800 pixel resolution, two camera inputs, a USB and a HDMI port, optimized user interface, video and image capturing in real time on SD card, playback of recorded video clips and still images, data transfer from SD card to USB flash drive possible, splash-proof according to IP54, suitable for wipe disinfection, shock-resistant ABS plastic housing, intelligent power management with rechargeable Li-Ion batteries, VESA 75 mounting option, power adaptor for EU, UK, USA and Australia, power supply VAC, 50/60 Hz, for use with CMOS video endoscopes including: Protection Cap VESA 75 Quick Clip Mains Adaptor Set 8403 X C-MAC Connecting Cable, with C-MAC system interface, for C-MAC Monitor 8403 ZXK or C-HUB II , length 200 cm, for usew with C-MAC Video Laryngoscopes 8403 xxx 8

9 8403 HX C-MAC Video Laryngoscope D-BLADE, CMOS technology, for difficult intubation in adults, with C-MAC system interface, documentation of images and video sequences via BlueButton, with catheter introduction sizes Fr., for use with C-MAC Connecting Cable 8403 X for C-MAC Monitor 8403 ZXK or C-HUB II as well as C-MAC PM 8403 XD 8403 HXP Same, pediatric, without catheter introduction 8403 BXC C-MAC Video Laryngoscope MAC #4, CMOS technology, with MACINTOSH laryngoscope blade, size 4, with C-MAC system interface, documentation of images and video sequences via BlueButton, for use with C-MAC Connecting Cable 8403 X for C-MAC Monitor 8403 ZXK or C-HUB II as well as C-MAC PM 8403 XD 8403 AXC Same, size BX C-MAC Video Laryngoscope MAC #4, CMOS technology, with MACINTOSH laryngoscope blade, size 4, with C-MAC system interface, documentation of images and video sequences via BlueButton, with catheter introduction sizes Fr., for use with C-MAC Connecting Cable 8403 X for C-MAC Monitor 8403 ZXK or C-HUB II as well as C-MAC PM 8403 XD 8403 AX Same, size 3, with catheter introduction sizes14-16 Fr DS C-MAC GUIDE, guide rod made of stainless steel with atraumatic tip, distal region is adapted to the blade shape of the C-MAC video laryngoscope D-BLADE, fixation of endotracheal tube with the integrated tube holder possible, package of 10, for use with C-MAC video laryngoscopes 9

10 C-MAC S Video Laryngoscope C-MAC S for single use has the same outstanding features that distinguish C-MAC metal performance blades. As a result, great value was also attached to maintaining the original MACINTOSH blade design. The D-BLADE is, of course, available as C-MAC S. The imager enables blades to be exchanged within seconds and, as a camera, it forms the interface to the C-MAC monitor. The C-MAC S video laryngoscope is just as flexible and mobile as other C-MAC laryngoscopes Consequently, the instrument is ideally suited for all emergency and preclinical situations as it practically eliminates the need for complex transportation and reprocessing procedures. With C-MAC S you continue to profit from all the familiar benefits offered by the C-MAC system: the only difference is that the C-MAC S blade is designed for single use XS C-MAC S Imager, for manual and machine disinfection up to 65 C and High Level Disinfection (HLD) acc. to US standards, for use with C-MAC Monitor 8403 ZX and single-use C-MAC S Video Laryngoscopes , and

11 * C-MAC S Video Laryngosccope MAC #3, with MACINTOSH laryngoscope blade, size 3, for single use, package of 10, for use with KARL STORZ C-MAC S Imager 8402 XS/8403 XS and C-MAC Monitor 8403 ZX C-MAC S Video Laryngoscope MAC #4, with MACINTOSH laryngoscope blade, size 4, for single use, package of 10, for use with KARL STORZ C-MAC S Imager 8402 XS/8403 XS and C-MAC Monitor 8403 ZX C-MAC S Video Laryngoscope D-BLADE, laryngoscope blade for difficult intubation, for single use, package of 10, for use with KARL STORZ C-MAC S Imager 8402 XS/8403 XS and C-MAC Monitor 8403 ZX * 11

12 C-MAC PM Video Laryngoscope The C-MAC pocket monitor can also be used with MACINTOSH #4, D-BLADE and all other C-MAC video laryngoscopes. The pocket monitor stands out due to its high degree of flexibility and practicality. The OTI display ("open-to-intubate") enables the C-MAC PM to be rotated towards the user for awake intubation of adipose patients, even via a Tomahawk approach XDK 8403 XDL 8403 XDA 8403 XDP 8403 XDK C-MAC Pocket Monitor Set, unit with LCD monitor and power supply for all C-MAC video laryngoscopes, with C-MAC system interface, screen size 3.5", documentation of images and video sequences saved on internal memory, monitor movable via two rotation axes, rechargeable Li-Ion battery, 1 h operation time, exchangeable battery pack, 2 h charging time, power management with capacity indicator, protection class IPX 8 including: C-MAC Pocket Monitor Battery, for C-MAC PM, rechargeable USB Data Cable, for C-MAC PM 8403 XDL Charging Unit, for one portable Battery 8403 XDA for C-MAC Pocket Monitor 8403 XD, with power supply and mains adaptor for EU, UK, USA and AUS, power supply VAC, 50/60 Hz, suitable for wipe disinfection 8403 XDA Battery for C-MAC PM, rechargeable Li-Ion battery for power supply of C-MAC PM 8403 XD, suitable for wipe disinfection, charging via Charging Unit 8403 XDL, optimal operation time of 60 min, for use with C-MAC Pocket Monitor 8403 XD 8403 XDP C-MAC PM Connecting Cable, for the transmission of digital signals from C-MAC PM 8403 XD to C-MAC Video Laryngoscopes 8403xxx (C-MAC system interface), length 50 cm 12

13 FIVE Flexible Intubation Video Endoscope Flexible awake intubation is the most common technique performed in the expected difficult airway. The new flexible intubation video endoscope (FIVE) delivers clear, pixel-free images in 4:3 format without a Moiré pattern. The flexible intubation video endoscope can be directly connected to the C-MAC monitor. This enables immediate changover to the C-MAC video laryngoscope, if required. Complete view instead of tunnel vision BNXK BNXK Flexible Intubation Video Endoscope Set 5.5 x 65, CMOS technology, with suction valve, for use with C-MAC Monitor 8402 ZX/8403 ZX and C-HUB Deflection up/down: 140 /140 Direction of view: 0 Angle of view: 120 Working length: 65 cm Total length: 94 cm Working channel inner diameter: 2.1 mm Distal tip outer diameter: 5.5 mm BDXK Flexible Intubation Video Endoscope Set 4.0 x 65, CMOS technology, with suction valve, for use with C-MAC Monitor 8403 ZX and C-HUB Deflection up/down: 140 /140 Direction of view: 0 Angle of view: 100 Working length: 65 cm Total length: 93 cm Working channel inner diameter: 1.5 mm Distal tip outer diameter: 4.0 mm 13

14 BONFILS Retromolar Intubation Endoscope After more than 30 years, the BONFILS intubation endoscope has become a mainstay in airway management. With its versatile intubation techniques, difficult airways can be brought to a controlled status. It is particularly beneficial for patients that present with a small mouth opening or reduced reclination of the neck, which is often characteristic of obese patients. The endotracheal tube is guided into the trachea under direct vision. The possibility of simultaneous application of oxygen provides more user safety B2K B2K BONFILS Retromolar Intubation Endoscope, basic set, autoclavable, 35,000 pixels, outer diameter 5 mm, for ETT > 5.5 mm, usable sheath length 40 cm, distal bending 40, with movable eyepiece C-CAM Camera Head, 8-pin, one-chip CMOS camera head, resolution 640 x 480, focal length f = 20 mm, compatible with C-MAC 8402 ZX/8403 ZX 14

15 11301 DE DF DG DE Battery Light Source LED for Endoscopes, rechargeable, with click connection, boost mode for temporary increase in brightness, color temperature 5500 K, lithium-ion batteries, charging time 60 min, burning time at 100% brightness 40 min, weight approx. 150 g, suitable for wipe disinfection DF Battery Light Source LED for Endoscopes, rechargeable, with fast screw thread, boost mode for temporary increase in brightness, color temperature 5500 K, lithium-ion batteries, charging time 60 min, burning time at 100% brightness 40 min, weight approx. 150 g, suitable for wipe disinfection DG Charging Unit, for two LED battery light sources, with fixed integrated power supply and adaptor for EU, UK, USA and Australia, power supply VAC, 50/60 Hz, suitable for surface disinfection It is recommended to check the suitability of the product for the intended procedure prior to use. 15

16 KARL STORZ GmbH & Co. KG Mittelstraße 8, Tuttlingen, Germany Postbox 230, Tuttlingen, Germany Phone: +49 (0) Fax: +49 (0) AN /2016/EW-E