The Inventor’s Point of View

inventors pov

The Inventor’s Point of View

As a practicing anesthesiologist for over 30 years, I have seen my share of airway management problems. We all have heard the axiom in anesthesia, 99% boredom and 1% sheer terror. Now I would disagree with anesthesia being boring. It has filled my life with great interest, continued learning and passion. As I look back through the years, many of my “hair-raising stressers” in anesthesia have occurred during airway management. Whether from difficult intubation, ventilation or inadvertent extubation, there’s a common theme: the inability to provide ventilation with time being the enemy. Oxygen consumption combined with limited ventilation can lead to a disastrous situation of hypoxemia and its subsequent consequences. Airway management has certainly evolved, being safer than ever before. Technology and training have combined to contribute to this increased safety. The advent of capnography, pulse oximetry, laryngeal airway mask (LAM) and video laryngoscope have promoted safe practice.

In the 1990s a more concerted effort to promote guidelines for airway management was established. The American Society of Anesthesiology (ASA) provided a framework through an airway management algorithm. This algorithm continually evolves based on scientific data. Numerous societies across the globe have begun to focus solely on the science of airway management such as The Society of Airway Management (SAM) and Difficult Airway Society (DAS) to name a couple.

My present inventions are a continuation of my dream of making airway management easier, simpler and safer for all healthcare providers. The common themes include easy ventilation with continued visualization, the ability to intubate during ventilation and providing a platform for extubation while maintaining a stented airway. Reintubating through this rescue device as a rescue procedure would be an added plus. Many years ago, I wondered if the laryngeal airway mask (LAM) could be the platform to provide this dream.

hand with lightbulbThe LAM is relatively easy to place and establishes ventilation in some 95% of individuals. It is less stimulating than an endotracheal tube yet has the ability to provide a conduit for intubation. A fiber optic scope could provide this intubation with the potential of continued visualization. Extubating into a LAM can maintain a stented airway but has no visualization. I suppose we could take that fiber optic scope and place it into the LAM to achieve the needed visualization, but we would need some sort of swivel adapter to provide a closed conduit for the bronchoscope during ventilation. However, this bronchoscope would take up space inside the endotracheal tube (ETT) potentially increasing airway pressures especially with a smaller sized ETT. As you can see this entails multiple devices and adds unnecessary complexities.

The laryngoscope has been the gold standard for intubation for 80 years or more. It has a significant learning curve and is not successful in all applications. It cannot provide ventilation or positive pressure ventilation. There is no ability to extubate into a laryngoscope while providing ventilation, thus no ability to rapidly reintubate. Lifting with a laryngoscope blade stimulates hemodynamics and causes added trauma. Even with the advent of the video laryngoscope, it provides visualization only at the time of intubation. At the end of the day, it’s just a laryngoscope.

The common description of an anterior larynx seems to melt away with a camera based laryngeal airway mask. Mallampatti classifications were designed solely for predicting the ease of laryngoscopy. It provides no correlation to establishing ventilation with a laryngeal airway mask. The LAM by its sheer design, provides a conduit to the glottis. Integrating a camera in close proximity to the intubating tube verifies ventilation, proper placement and during extubation provides continued visualization. Extubating into a camera based laryngeal airway mask could provide the ability to rapidly reintubate while maintaining ventilation.

The laryngeal airway mask (LAM) is currently the global rescue device for CICO (cannot intubate cannot oxygenate) scenarios and not all airway scenarios are created equal. Airway management involves a continuum of circumstances each requiring a different solution. Why not make the LAM with a camera the basis for laryngoscopy with vision during ventilation, intubation, extubation and potential reintubation? Essentially, why not make this our modern-day laryngoscope? I believe this would make it safer and easier for healthcare professionals to engage this continuum.

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