Name:
AccessSurgery - Tracheal Intubation Using the Fastrach
Description:
AccessSurgery - Tracheal Intubation Using the Fastrach
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/265d257f-6da7-4b5b-a421-1e7cbad58997/thumbnails/265d257f-6da7-4b5b-a421-1e7cbad58997.jpg?sv=2019-02-02&sr=c&sig=yeAw2II%2Bw3%2Fd33k15%2BoFL3LZrHgfMhlKBRYMPJGyAfc%3D&st=2025-05-11T14%3A35%3A34Z&se=2025-05-11T18%3A40%3A34Z&sp=r
Duration:
T00H06M09S
Embed URL:
https://stream.cadmore.media/player/265d257f-6da7-4b5b-a421-1e7cbad58997
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/265d257f-6da7-4b5b-a421-1e7cbad58997/AccessSurgery20-20Tracheal20Intubation20Using20the20Fastrach.avi?sv=2019-02-02&sr=c&sig=UldvyRroQps%2Bj3XZA5fJW325K7YYBZi4IoKvNUV%2BzhE%3D&st=2025-05-11T14%3A35%3A34Z&se=2025-05-11T16%3A40%3A34Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 Introduction.
In addition to ventilation, the intubating LMA, or Fastrach, can also facilitate tracheal intubation. While tracheal intubation can be performed via the LMA Classic, it is substantially more successful using the Fastrach.
Segment:2 The Device.
The Fastrach has a rigid metal curved airway tube with a guiding handle, an epiglottic elevating bar, a deeper bowl cuff than the LMA Classic, and a ramp that directs the endotracheal tube anteriorly into the larynx.
While a regular polyvinyl chloride endotracheal tube can be used for tracheal intubation through the Fastrach, the dedicated, wire-reinforced, silicone-tipped tracheal tube supplied with the Fastrach has been shown to give the highest success rates. A stabilizing rod is provided with the Fastrach to hold the endotracheal tube in position while withdrawing the Fastrach after completion of the intubation.
Segment:3 Preparation.
To facilitate placement of the Fastrach and tracheal intubation, it is necessary to lubricate the Fastrach and the tracheal tube, including the connector of the tracheal tube. Prior to intubation, it is also necessary to lubricate the internal surface of the metal curved airway tube by pushing the lubricated tracheal tube through the Fastrach.
The head and neck of the patient should be placed in a sniffing position.
Segment:4 Technique of Intubation.
In order to have clear access to the glottic opening during the placement of the Fastrach, it is necessary to perform a jaw lift to facilitate placement of the tip of the Fastrach into the hypopharynx.
The dominant hand than grasps the metal tube of the Fastrach and inserts the device straight back over the tongue to the back of the oropharynx. Advance the cuff into the hypopharynx by rotating the device using the metal handle while maintaining pressure against the palate and following the palatopharyngeal curve. Once in place, inflate the cuff to achieve a seal for manual ventilation.
If ventilation is difficult or inadequate, reposition the Fastrach before proceeding to tracheal intubation. The Chandy maneuver, which consists of rotating and lifting the mask in the sagittal plane with the use of the metal handle, can optimize the seal and facilitate ventilation and intubation.
To facilitate placement of the tracheal tube through the glottic opening, it is important to tilt the metal handle toward the chin in order to align the exit of the metal tube with the trachea. With the black vertical line on the silicone-tipped tracheal tube facing the operator, insert the tube into the metal lumen of the Fastrach until the horizontal black line on the tracheal tube meets the proximal end of the Fastrach.
At this point, the tip of the tracheal tube is just emerging from beneath the epiglottic elevating bar. Resistance will be felt as the tip of the tube elevates this bar and exits the distal end of the Fastrach to enter the patient's glottis. Tracheal placement is confirmed by end-tidal carbon dioxide detection. If end-tidal carbon dioxide is not detected, the cuff of the tube should be deflated and withdrawn into the Fastrach.
Redirection and manipulation of the Fastrach by the metal handle may enhance successful passage. Recent evidence suggests that the Fastrach in situ produces sufficient pressure on the posterior hypopharyngeal wall to potentially compromise mucosal blood flow. For this reason, it is recommended that the Fastrach device be withdrawn over the tracheal tube, particularly when prolonged use is anticipated.
A stabilizing rod is used to hold the endotracheal tube in position while the Fastrach is withdrawn as shown in the video.
Segment:5 Troubleshooting.
It should be emphasized that insertion of the Fastrach may be difficult if the mouth opening is limited with an inter-dental gap of less than two centimeters. This blind intubating technique has been reported to have a first time success rate of 73% and an overall success rate of 90%.
Light-guided techniques employing a flexible light wand, such as the Trachlight, have been shown to improve the success rate. As shown in this video, using the glow, the Trachlight can guide the tip of the endotracheal tube through the glottic opening and into the trachea. Alternatively, tracheal intubation can be performed through the Fastrach using a flexible fiber optic bronchoscope and the FAST scope.
To prevent damage to the tip of the flexible scope during intubation, the silicone-tipped tracheal tube should be first advanced through the Fastrach until the tip of the tube exits under the elevating bar. The flexible bronchoscope is then advanced through the tracheal tube into the trachea to facilitate subsequent intubation. Fiberoptic guided intubation through the Fastrach has also been shown to improve the success rate and intubating LMA with a video display has recently been introduced.
This new intubating LMA is called the CTrach. As shown in this video, the CTrach can be used to visualize the advancement of the endotracheal tube through the metal tube into the trachea.
Segment:6 Summary.
In addition to providing ventilation, the Fastrach LMA is designed to facilitate tracheal intubation. Successful tracheal intubation using this device requires careful preparation of the device and regular practice of the intubating technique.
The success rate of tracheal intubation can be improved if the device is used together with the Trachlight, a flexible fiber optic scope, or the use of a newly introduced CTrach intubating LMA with a video display.
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