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simultaneously
withdraw the
airway until
ventilation is easy
and free flowing
(large tidal volume
with minimal airway
pressure).
14. Depth markings are provided
at the proximal end of the
KING LT(S)-D which refer to the
distance from the distal
ventilatory openings. When properly
placed with the distal tip and cuff in the
upper esophagus and the ventilatory
openings aligned with the opening to
the larynx, the depth markings give an
indication of the distance, in cm, to the
vocal cords.
15. Confirm proper position by auscultation
and chest movement or verification of
CO 2 by capnography.
16. Readjust cuff inflation to 60 cm H 2 O (or
to just seal volume).
17. Secure KING LT(S)-D to patient using
tape or other accepted means. A bite
block can also be used, if desired.
DO NOT COVER THE PROXIMAL
OPENING OF THE GASTRIC ACCESS
LUMEN OF THE KING LTS-D.
18. KING LTS-D Only: The
gastric access lumen
allows the insertion of
up to a 18 Fr diameter
gastric tube into the
esophagus and
stomach. Lubricate
gastric tube prior to insertion.
REMOVAL OF THE KING LT(S)-D
1.
Once it is in the correct position, the
KING LT(S)-D is well tolerated until the
return of protective reflexes.
2.
KING LT(S)-D removal should always be
carried out in an area where suction
equipment and the ability for rapid
intubations are present.
3.
For KING LT(S)-D removal, it is important
that both cuffs are completely deflated.
USER TIPS
1.
The key to insertion is to get the distal
tip of KING LT(S)-D around the corner in
the posterior pharynx, under the base of
the tongue. Experience has indicated
that a lateral approach, in conjunction
with a chin lift, facilitates placement of
the KING LT(S)-D. Alternatively, a
15011 Herriman Boulevard, Noblesville, IN 46060 l (317) 776-6823 (800) 642-5464 l Fax (317) 776-6827 l www.kingsystems.com
KING LT-D
INFM-63
05/10
laryngoscope or tongue depressor can
be used to lift the tongue anteriorly to
allow easy advancement of the
KING LT(S)-D into position.
2.
Insertion can also be accomplished via a
midline approach by applying a chin lift
and sliding the distal tip along the
palate and into position in the
hypopharynx. In this instance, head
extension may also be helpful.
3.
As the KING LT(S)-D is advanced around
the corner in the posterior pharynx, it is
important that the tip of the device is
maintained at the midline. If the tip is
placed or deflected laterally, it may enter
the piriform fossa and the tube will
appear to bounce back upon full
insertion and release. Keeping the tip at
the midline assures that the distal tip is
placed properly in the
hypopharynx/upper esophagus.
4.
Depth of insertion is key to providing a
patent airway. Ventilatory openings of
the KING LT(S)-D must align with the
laryngeal inlet for adequate
oxygenation/ventilation to occur.
Accordingly, the insertion depth should
be adjusted to maximize ventilation.
Experience has indicated that initially
placing the KING LT(S)-D deeper (until
base of connector aligns with teeth or
gums), inflating the cuffs and
withdrawing until ventilation is
optimized results in the best depth of
insertion for the following reasons:
•
It ensures that the distal tip has not
been placed laterally in the piriform
fossa (see item #3 above).
•
With a deeper initial insertion, only
withdrawal of the tube is required to
realize a patent airway. A shallow
insertion will require deflation of the
cuffs to advance the tube deeper
(several added steps).
•
As the KING LT(S)-D is withdrawn, the
initial ventilation opening exposed to or
aligned with the laryngeal inlet is the
proximal opening. Since the proximal
opening is closest to and is partially
surrounded by the proximal cuff, airway
obstruction is less likely, especially when
spontaneous ventilation is employed.
•
Withdrawal of the KING LT(S)-D with the
balloons inflated results in a retraction of
tissue away from the laryngeal inlet,
thereby encouraging a patent airway
5.
When the patient is allowed to breathe
spontaneously, airway obstruction can
KING SYSTEMS
TM
and KING LTS-D
TM
are trademarks of King Systems. U.S. Patent: 5,819,733. © 2009 King Systems.
ENGLISH
occur even though no obstruction was
detected during assisted or positive
pressure ventilation. During
spontaneous ventilation, the epiglottis or
other tissue can be drawn into the
ventilatory opening, resulting in
obstruction. Advancing the
KING LT(S)-D 1-2 cm or initial deeper
placement (see item #4 above) normally
eliminates this obstruction.
Epiglottis
Epiglottis
Epiglottis obstructing
KING LT(S)-D advanced to
distal ventilatory opening
6.
Ensure that the cuffs are not over
inflated. Cuff pressure should be
adjusted to 60 cm H 2 O. If a cuff
pressure gauge is not available, inflate
cuffs with the minimum volume
necessary to seal the airway at the peak
ventilatory pressure employed (just seal
volume). Note that nitrous oxide is
known to diffuse into cuffs and increase
pressure; accordingly, if using nitrous
oxide, cuff pressures should be
monitored periodically to avoid over-
inflation.
7.
Maintain appropriate depth of
anesthesia. In general, the depth of
anesthesia needed is a little more than
that required for insertion of a Guedel-
type airway. It is recommended that the
less experienced user choose a slightly
deeper level of anesthesia.
8.
Removal of the KING LT(S)-D is well
tolerated until the return of protective
reflexes. For later removal, it may be
helpful to remove some air from the
cuffs to reduce the stimulus during wake-
up.
relieve obstruction
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