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QUICK GUIDE
 

Use an Aintree to place an ETT following rescue LMA placement

First, ensure the LMA is in place and well seated

Continue 100% oxygen

Confirm adequate sedation/anesthesia

Confirm ventilation & paralysis

What is an
Aintree?

  • Flexible catheter used for fiberoptically converting an LMA to an oral ETT

  • aka. Airway Intubation Catheter (AIC)

  • Shorter than an airway exchange catheter so that...

  • ... it can be preloaded onto a bronchoscope

  • Compatible with any "intermediate" sized bronchoscope (i.e. the Olympus 4-0 or the Verathon Slim 3.8mm)

  • Compatible with a 7-0 ETT (a smaller ETT cannot be railroaded over the Aintree)

  • Following intratracheal placement, a 7-0 ETT can be railroaded over Aintree and into the trachea

  • Comes with 2 "rapifit" adaptors (please refer to manufacturer’s guidelines for use)

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first.
Prep patient.
Prep equipment.

  1. Attach bronchoscope elbow to LMA and connect to anesthesia circuit

  2. Confirm adequate anesthesia, muscle relaxation and assisted ventilation

  3. Use silicone spray to lightly lubricate the Aintree, LMA, ETT and scope

  4. Preload Aintree onto scope and secure with tape or rubber band

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Next...

  1. Have an assistant stabilize the LMA in place and hold jaw thrust, as necessary 

  2. Introduce preloaded scope through bronch elbow and into the LMA lumen

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then
Guide scope into trachea

  1. Sequentially visualize and advance bronchoscope through LMA, through the glottis, and into the trachea 

  2. Advance to the carina but never beyond (in rare circumstances the airway catheters have caused blunt trauma to the lower airways)

Remove scope

  1. Note depth of Aintree using printed hashmarks

  2. Remove tape or rubber band securing Aintree to scope

  3. Maintain the position of the Aintree while removing the scope 

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Remove LMA

  1. Use particular care at this point to avoid Aintree dislodgment or mainstemming

  2. Disconnect LMA from bronch elbow and circuit

  3. Withdraw LMA while applying counter pressure on Aintree to prevent Aintree dislodgment from trachea

  4. Once the LMA cuff becomes visible, grasp Aintree in the mouth and fully remove LMA

  5. Avoid main stemming - note the depth of AIC at the teeth, ensuring that it never exceeds 23cm in females, 26 cm in males

Railroad ETT

  • Railroad the 7-0 ETT over Aintree (the 7-0 ETT smallest ETT compatible with the Aintree)

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Secure ETT

  1. Inflate cuff, reconnect circuit and re-establish anesthesia and ventilation.

  2. Confirm end-tidal CO2.

  3. Consider bronch confirmation of ETT position

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Need more details?

Take a look here for a more exhaustive explanation of this technique.

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How-to video

If a picture is worth a thousand words...

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Got questions?

Read here for answers to some frequently asked questions.

 

 This should be performed in a controlled stepwise process


  • The process is designed to provide continuous ventilation/oxygenation via the LMA and bronch adaptor until the LMA is removed and ETT is railroaded in place


  • Oxygen CAN be delivered via the Aintree in situations where railroading of ETT is prolonged; assisting ventilation via this route is often suboptimal and carries significant risk (narrow diameter/lack of cuff/elevated barotrauma risk) 


  • Refer to manufacturer’s guidelines for methods of oxygen delivery

 

 

Additional Recommendations:

  1. Consider a second anesthesia provider in addition to a trained assistant

  2. The Aintree catheter is not recommended with the LMA Supreme

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