Ambu AuraStraight Bedienungsanleitung Seite 11

3.3. Insertion
• Never use excessive force.
• Hold the Ambu AuraStraight like a pencil, with the
index finger placed at the transition between the cuff
and the patient tube. Your other hand should be placed
under the patient's head. 4
• Insert the tip of the cuff pressing upwards against the
hard palate and flatten the cuff against it. 5
• Verify that the tip of the cuff is flattened against
the palate before proceeding – push the jaw gently
downwards with your middle finger to open the
mouth further.
• Ensure that the tip of the cuff avoids entering the
valleculae or the glottic opening and does not become
caught up against the epiglottis or the arytenoids. The
cuff should be pressed against the patient's posterior
pharyngeal wall.
• When the mask is in place, resistance will be felt.
• Before pulling back the hand holding the mask, the
other hand is used to press down on the airway tube.
This ensures that the Ambu AuraStraight stays in place
when the finger is removed.
• After insertion ensure lips are not trapped between
patient tube and teeth to avoid trauma to lips.
INSERTION PROBLEMS
• For pediatric patients, a partial rotational technique is
recommended in case of placement difficulties.
• Coughing and breath-holding during Ambu
AuraStraight insertion indicates inadequate depth
of anesthesia – Immediately deepen anesthesia
with inhalational or intravenous agents and initiate
manual ventilation.
• If you cannot open the patient's mouth sufficiently to
insert the mask, check that the patient is adequately
anesthetized. Ask an assistant to pull the jaw
downwards thus making it easier to see into the mouth
and verify the position of the mask.
• For difficulty in maneuvering the angle at the back of
the tongue when inserting AuraStraight, press the tip
against the palate throughout or else the tip may fold
on itself or meet an irregularity in the posterior
pharynx, e.g., hypertrophied tonsils. Should the cuff fail
to flatten or begin to curl over as it is inserted, withdraw
the mask and reinsert it. In case of tonsillar obstruction,
a diagonal movement of the mask is recommended.
3.4. Fixation
If deemed necessary, secure AuraStraight to the patient's
face with adhesive tape or with a mechanical tube holder
suited for this purpose. 7 It is recommended to use a
gauze bite block.
3.5. Inflation
• Without holding the tube, inflate the cuff with just
enough air to obtain a seal, equivalent to intracuff
pressures of a maximum of 60 cm H O. 6 Often only half
2
of the maximum volume is sufficient to achieve a seal –
please refer to Table 1 for maximum intracuff volumes.
• Monitor the cuff pressure continuously during the
surgical procedure with a cuff pressure gauge. This is
especially important during prolonged use or when
nitrous oxide gases are used.
• Look for the following signs of correct placement: The
possible slight outward movement of the tube upon
cuff inflation, the presence of a smooth oval swelling in
the neck around the thyroid and cricoid area, or no cuff
visible in the oral cavity.
• The mask may leak slightly for the first three or four
breaths before settling into position in the pharynx. In
case leakage persists, check that there is adequate
depth of anesthesia and that the pulmonary inflation
pressures are low before assuming that reinsertion of
AuraStraight is necessary.
3.6. Verification of correct position
• Correct placement should produce a leak-free seal
against the glottis with the tip of the cuff at the upper
oesophageal sphincter.
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