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Hans Huitink

@AirwayMxAcademy • 14,943 subscribers

Anesthesiologist🇳🇱Founder Airway Management Academy non-profit airway teaching #AAF26| Mobile Critical Care Support😷🚑🩺 | AirAmbulance🛩 @AirwayTriageApp

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Hyperangulated blade 4 VL #VL

Hyperangulated blade 4 VL #VL

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Cuff mediated airway alignement 🎥👇🏼 Paediatric nasal intubation, tube 4.5 RAE. McGrath VL. Tube impingement on arytenoids, easily fixed by airway alignment. An “old airway trick revisited” Cuff-mediated airway alignment is an advanced intubation technique where the cuff of a tracheal tube (TT) is temporarily inflated to mechanically adjust and center the tube tip with the glottic opening. This maneuver is primarily utilized during difficult intubations—such as when utilizing a videolaryngoscope in patients with restricted mouth opening or an anteriorly positioned larynx—to lift the tube off the posterior pharyngeal wall and direct it smoothly into the trachea. How the Procedure Works: The technique relies on a structured, step-by-step sequence to prevent tissue trauma: [1] Initial Advancement: The clinician advances the TT into the oropharynx using visual guidance from a device like the C-MAC Videolaryngoscope. [1, 2, 3] Cuff Inflation: If the tube tip hinges on local anatomy or misaligns with the glottis, air is gradually introduced into the cuff. Alignment: As the cuff expands against the surrounding pharyngeal structures, it physically pushes and centers the tube shaft, aligning the TT tip directly with the laryngeal inlet. Deflation and Passage: Once optimal alignment is achieved, the cuff is completely deflated so the tip can safely pass through the vocal cords without causing mucosal tearing or laryngeal injury. Final Positioning: The tube is advanced to its proper tracheal depth, and the cuff is re-inflated to establish a definitive ventilatory seal. Clinical Advantages: Navigates Difficult Anatomy: It overcomes "extreme anterior" laryngeal positioning where standard stylets or maneuvers fail to center the tube. Reduces Posterior Hinging: It stops the ETT from getting trapped or scraping against the posterior pharyngeal wall during nasotracheal or videolaryngoscopic intubations. Disadvantages & Safety Risks: Visual Obstruction: Overinflating the cuff within the upper airway can expand the balloon so wide that it completely blocks the clinician's view of the TT by the uvula or cuff. Blind Advancement Risk: If the clinician attempts to push the tube forward before deflating the cuff, it can cause severe friction, mucosal trauma, or nerve compression within the laryngeal space. First publication In Ghana medical Journal in 2011 📖 📖 #airway #nasalintubation #airwayalignement #foamed

Cuff mediated airway alignement 🎥👇🏼 Paediatric nasal intubation, tube 4.5 RAE. McGrath VL. Tube impingement on arytenoids, easily fixed by airway alignment. An “old airway trick revisited” Cuff-mediated airway alignment is an advanced intubation technique where the cuff of a tracheal tube (TT) is temporarily inflated to mechanically adjust and center the tube tip with the glottic opening. This maneuver is primarily utilized during difficult intubations—such as when utilizing a videolaryngoscope in patients with restricted mouth opening or an anteriorly positioned larynx—to lift the tube off the posterior pharyngeal wall and direct it smoothly into the trachea. How the Procedure Works: The technique relies on a structured, step-by-step sequence to prevent tissue trauma: [1] Initial Advancement: The clinician advances the TT into the oropharynx using visual guidance from a device like the C-MAC Videolaryngoscope. [1, 2, 3] Cuff Inflation: If the tube tip hinges on local anatomy or misaligns with the glottis, air is gradually introduced into the cuff. Alignment: As the cuff expands against the surrounding pharyngeal structures, it physically pushes and centers the tube shaft, aligning the TT tip directly with the laryngeal inlet. Deflation and Passage: Once optimal alignment is achieved, the cuff is completely deflated so the tip can safely pass through the vocal cords without causing mucosal tearing or laryngeal injury. Final Positioning: The tube is advanced to its proper tracheal depth, and the cuff is re-inflated to establish a definitive ventilatory seal. Clinical Advantages: Navigates Difficult Anatomy: It overcomes "extreme anterior" laryngeal positioning where standard stylets or maneuvers fail to center the tube. Reduces Posterior Hinging: It stops the ETT from getting trapped or scraping against the posterior pharyngeal wall during nasotracheal or videolaryngoscopic intubations. Disadvantages & Safety Risks: Visual Obstruction: Overinflating the cuff within the upper airway can expand the balloon so wide that it completely blocks the clinician's view of the TT by the uvula or cuff. Blind Advancement Risk: If the clinician attempts to push the tube forward before deflating the cuff, it can cause severe friction, mucosal trauma, or nerve compression within the laryngeal space. First publication In Ghana medical Journal in 2011 📖 📖 #airway #nasalintubation #airwayalignement #foamed

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During URSI (Ultra Rapid Sequence Intubation) use the videolaryngoscope as a “spy around the corner” and see when the cords are opening 🎥 Important points: 1. insert the blade very gently, dont cause vomiting !) 2. this works well with high dose rocuronium, a bit more challenging with sux due to muscle depolarisation and twitching 3. use lubricating gel to lubricate the innercurve of the blade 4. place the patient in head-up position 5. have suction ready 👉intubation procedure can start after 30 seconds #speedygonzalez James DuCanto, M.D. Cliff Reid Dave Olvera carmine della vella INTUBATIEM Simon Carley Sam Ghali, M.D.

During URSI (Ultra Rapid Sequence Intubation) use the videolaryngoscope as a “spy around the corner” and see when the cords are opening 🎥 Important points: 1. insert the blade very gently, dont cause vomiting !) 2. this works well with high dose rocuronium, a bit more challenging with sux due to muscle depolarisation and twitching 3. use lubricating gel to lubricate the innercurve of the blade 4. place the patient in head-up position 5. have suction ready 👉intubation procedure can start after 30 seconds #speedygonzalez James DuCanto, M.D. Cliff Reid Dave Olvera carmine della vella INTUBATIEM Simon Carley Sam Ghali, M.D.

44,797 views

Glottic web. Videolaryngoscopy is very helpful to share uncommon findings and ask for advice. This was a male patient with a hoarse voice. History of dyspnea during exercise, hypertension and heavy smoker. He needed general anaesthesia for knee surgery. We canceled the procedure and woke him up. Bag mask ventilation and oxygenation was easy. #VL #anaesthesia Sam Ghali, M.D. James DuCanto, M.D. Cliff Reid Dave Olvera Tanya

Glottic web. Videolaryngoscopy is very helpful to share uncommon findings and ask for advice. This was a male patient with a hoarse voice. History of dyspnea during exercise, hypertension and heavy smoker. He needed general anaesthesia for knee surgery. We canceled the procedure and woke him up. Bag mask ventilation and oxygenation was easy. #VL #anaesthesia Sam Ghali, M.D. James DuCanto, M.D. Cliff Reid Dave Olvera Tanya

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I had my first Ai Endoscopic airway lesson in Baveno 🇮🇹 during #EAC23 with David Guralnick, COO of Ai Endoscopic. Very interesting and exciting new technology. Will it make our airway management procedures safer? The future will tell... James DuCanto, M.D. Dave Olvera carmine della vella INTUBATIEM bob funnekotter Sam Ghali, M.D. @alexffuchs Max Sorbello Cliff Reid Tim Cook #airway #ai #foamed Imran Ahmad Difficult Airway Society (DAS)
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I had my first Ai Endoscopic airway lesson in Baveno 🇮🇹 during #EAC23 with David Guralnick, COO of Ai Endoscopic. Very interesting and exciting new technology. Will it make our airway management procedures safer? The future will tell... James DuCanto, M.D. Dave Olvera carmine della vella INTUBATIEM bob funnekotter Sam Ghali, M.D. @alexffuchs Max Sorbello Cliff Reid Tim Cook #airway #ai #foamed Imran Ahmad Difficult Airway Society (DAS)

Hans Huitink

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