*7.3.8.2 Device description*

Parts of the LTS-D (**Figures 17** and **18**):


The Proximal cuff stabilises the device and seals the oropharynx. Distal cuff blocks entry of the oesophagus, reducing the possibility of gastric insufflation. Multiple distal ventilatory openings and bilateral ventilation eyelets facilitate air flow. The device has a curvature of 60 degrees. Sealing pressures of 30 cm H20 or more are achievable.

## *7.3.8.3 Size selection, practical aspect*

Size selection is done on a weight basis (**Table 8**). The slim profile allows easy insertion; thus, it can be considered for airway management in patients with

restricted mouth opening. Since insertion is relatively easy and guarantees a clear airway in most patients on the first attempt extensive training is not necessary [93]. It can be used during spontaneous or controlled ventilation. The LTS-D has been recommended as an emergency device to be used in cases of difficult intubation and cannot intubate, cannot ventilate situations while one is preparing to perform a surgical airway [94–96]. A modification of this device, the Intubating Laryngeal Tube Suction-D(iLTS-D**™**) is a novel device which may also be used as a conduit

for intubation.

**271**

**Figure 18.** *LTS-D drain tube.*

**Figure 17.** *Parts of LTS-D.*

*Second Generation Supraglottic Airway (SGA) Devices DOI: http://dx.doi.org/10.5772/intechopen.93947*


#### *Second Generation Supraglottic Airway (SGA) Devices DOI: http://dx.doi.org/10.5772/intechopen.93947*

**Figure 17.** *Parts of LTS-D.*

*7.3.7.3 Size selection, practical aspect, adjuncts*

*Special Considerations in Human Airway Management*

*7.3.8 Ambu® king LTS-D™ (disposable laryngeal tube)*

Parts of the LTS-D (**Figures 17** and **18**):

• Inflation line with pilot balloon

*7.3.8.1 Introduction*

*7.3.8.2 Device description*

• Proximal cuff.

• Ventilation holes

• Distal cuff

• Drain tube

more are achievable.

**Table 7.**

**270**

*Available combitube.*

*7.3.8.3 Size selection, practical aspect*

Combitube® is commercially available in two sizes (**Table 7**). It has a major advantage over conventional ETT as it can be inserted without head and neck movement, which may be an important consideration in trauma patients [86]. Situations where ETT placement is not immediately possible, it is used for emergency airway control [87]. The Combitube® has been used effectively in cardiopulmonary resuscitation [88, 89]. It has been used successfully in difficult airway situations owing to severe facial burns, trauma, upper airway bleeding and vomiting where there was an inability to visualise the vocal cords [90–92].

The King Laryngeal Tube Suction-D**™** (Ambu®, Denmark) is a disposable, double-lumen, supralaryngeal device for airway management introduced in 2005. A single pilot tube can be used to inflate both oropharyngeal and oesophageal soft silicon cuff. A ventilating outlet opens in front of the vocal cords. It is present between these cuffs. It is available in six sizes to fit patients from neonates to large adults.

The Proximal cuff stabilises the device and seals the oropharynx. Distal cuff blocks entry of the oesophagus, reducing the possibility of gastric insufflation. Multiple distal ventilatory openings and bilateral ventilation eyelets facilitate air flow. The device has a curvature of 60 degrees. Sealing pressures of 30 cm H20 or

Size selection is done on a weight basis (**Table 8**). The slim profile allows easy

**Patient's height Combitube size** 4 to 6 feet tall 37 French 5 feet and above 41 French

insertion; thus, it can be considered for airway management in patients with

**Figure 18.** *LTS-D drain tube.*

restricted mouth opening. Since insertion is relatively easy and guarantees a clear airway in most patients on the first attempt extensive training is not necessary [93].

It can be used during spontaneous or controlled ventilation. The LTS-D has been recommended as an emergency device to be used in cases of difficult intubation and cannot intubate, cannot ventilate situations while one is preparing to perform a surgical airway [94–96]. A modification of this device, the Intubating Laryngeal Tube Suction-D(iLTS-D**™**) is a novel device which may also be used as a conduit for intubation.


**Table 8.** *Available LTS-D tubes.*

### *7.3.9 Baska mask®*

### *7.3.9.1 Introduction*

The Baska Mask® (Baska Versatile Laryngeal Mask Pty Ltd., Australia) has been designed by Australian anesthesists, Kanag and Meenakshi Baska. It obviates the need of an orogastric tube and replaces this with a sump and two drains. It brings together features of PLMA, SLMA, SLIPA and i-gel. The biggest advantage of Baska mask lies in the fact that cuff deflation or inflation is not required prior to insertion [97].
