Laryngeal tube

Laryngeal tube in a plexiglass model

The laryngeal tube (LT) is an aid for securing the airway . It represents an alternative to endotracheal intubation and is mainly used when the latter does not succeed, for example in the context of resuscitation , but also in the context of difficult airway management in anesthesia . The structure and function are similar to the Combitubus . Like the laryngeal mask, both are inserted blindly; the laryngeal tube almost always lies in the esophagus due to its design . In terms of handling, effectiveness and safety, it is on a par with these alternatives. Laryngeal tube is a trademark of VBM Medizintechnik, Sulz, Germany. It was developed in 1999.

construction

The laryngeal tube consists of a flexible plastic tube that is open at both ends. It has a lumen that ends between two cuffs (block cuffs for sealing). The upper, distal cuff surrounds the tube approximately in the middle and comes to rest in the throat after insertion , while the lower (proximal) cuff is attached to the end and lies in the esophagus after insertion. The lumen ends between the cuffs at the level of the larynx , so that the air introduced by the ventilator can flow into the lungs through the sealing of the cuffs up and down.

Since 2003 the laryngeal tube has been available in a modified version (LT-S) with an additional channel through which a gastric tube can be placed. This channel also serves as a valve against possible overinflation and rupture of the esophagus without inserting a gastric tube.

application

Using the laryngeal tube is easier than performing endotracheal intubation . The laryngeal tube is inserted blindly over the patient's mouth without the use of a laryngoscope , with the head in a neutral position or the neck slightly overstretched. It is helpful to actively deflate the cuffs again before applying, as the production process - especially after long periods of storage - means that the cuffs may contain some residual air. It is important to ensure that the oropharynx is free from foreign bodies. In addition, the tongue should be held in position using the Esmarch handle or splinting with the index finger in order to avoid incorrect positioning of the laryngeal tube through the tongue located in the back of the throat. Correctly inserted, the laryngeal tube comes to rest in the esophagus. After the blocking (filling of the cuffs), ventilation can be carried out with the help of a ventilation bag or device. According to the resuscitation guidelines of the European Resuscitation Council (ERC) of 2010, the laryngeal tube is the means of choice for inexperienced people for securing the airway, because it does not, unlike tracheal intubation, the risk of an undetected tube misalignment (which in inexperienced between 2.4 and 17 %).

With prolonged use of the laryngeal tube, swelling of the tongue can occur due to the obstruction of the blood flow. Other side effects - as with other intubations - can include an airway obstruction and damage to the mucous membrane of the pharynx. In addition, overinflation of the stomach with possible rupture of the esophagus is rarely described. Also, aspiration of gastric secretion in the lungs can not be excluded. An improvement on the original model is the LT-S already mentioned above, which is intended to prevent the latter two risks. In addition, the so-called iLTS-D (intubation laryngeal tube) was recently presented, with which, after the successful introduction of the iLTS-D, intubation with an endotracheal tube (Woodbridge tube) can be carried out via the lumen of the larynx tube.

Size coding

Sizes of laryngeal tubes
size	0	1	2	2.5	3	4th	5
colour	transparent	White	green	orange	yellow	red	violet
target group	Newborns <5 kg	Babies 5–12 kg	Infants 12-25 kg	older children 125–150 cm	small adults <155 cm	Adults 155-180 cm	large adults > 180 cm

Web links

Commons : Laryngeal tube  - collection of images, videos and audio files

• Illustrated step-by-step instructions rettungsdienst.de

Individual evidence

1. ↑ JP Nolan, CD Deakin, J. Soar et al. a .: European Resuscitation Council Guidelines for Resuscitation 2005. Section 4. Adult Advanced Life Support. In: Resuscitation. 67 Suppl. 1, 2005, pp. 39-86. PMID 16321716 .
2. ↑ K. Gerlach, Volker Dörges, Thomas Uhlig: The difficult airway. In: Anasthesiol Intensivmed Emergency Med Schmerzther. 41 (2), Feb. 2006, pp. 93-118. PMID 16493561 .
3. ↑ ^{a b c d} T. Asai, K. Shingu: The Laryngeal Tube. In: Br J Anaesth. 95 (6), Dec. 2005, pp. 729-736. PMID 16286348 .
4. ^ F. Agro, R. Cataldo, A. Alfano, B. Galli:. A New Prototype for Airway Management in an Emergency: The Laryngeal Tube. In: Resuscitation. 41, 1999, pp. 284-286. PMID 10507719 .
5. ↑ Volker Dörges, H. Ocker, V. Wenzel, M. Steinfath, K. Gerlach: The Laryngeal Tube S. A modified simple airway device? In: Anesth Analg. 96, 2003, pp. 618-621. PMID 12538222 .
6. ↑ ^{a b} J. Adler, M. Dykan: Gastric rupture: An Unusual Complication of the Esophageal Obturator Airway. In: Annals of Emergency Medicine . 12, 1983, pp. 224-225.
7. ↑ ERC Guidelines 2010, (PDF) p. 581.
8. ↑ Joshua B. Gaither, Jessica Matheson, Aaron Eberhardt, Christopher B. Colwell: Tongue Engorgement Associated With Prolonged Use of the King-LT Laryngeal Tube Device . In: Annals of Emergency Medicine . 2009.
9. ^ V. Dörges, H. Ocker, V. Wenzel, M. Steinfath, K. Gerlach: The Laryngeal Tube S: A Modified Simple Airway Device. In: Anesthesia & Analgesia. 96, 2003, pp. 618-621.
10. ↑ iLTS-D - Intubation Laryngeal Tube with Drainage Channel. VBM, accessed October 24, 2016 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !