The Tulip has been designed so that it does not require removal by the Anaesthetist after the cessation of surgery and anaesthesia. It is recommended that there be a delay in the reduction of anaesthetic/volatile percentage, as no manipulation of the airway is necessary.
The Tulip design allows easy access to the laryngeal inlet and the entrance of the oesophagus, as it forms the seal high in the oropharynx. It is possible to thoroughly examine the larynx and upper gastrointestinal tract by using a well lubricated endoscope and passing it through the central breathing tube lumen of the Tulip when in-situ.
The Tulip allows the approach to these previously perplexing specialties to be greatly simplified, in terms of anaesthetic management, manoeuvers and cost. It should be appreciated that the design of Tulip is based upon the principle of the air-tight oropharyngeal seal.
It should be appreciated that the design of Tulip is based upon the principle of the air-tight oropharyngeal seal. This air, blood and secretion-tight seal allows the device to generate manual ventilating pressure and confidently protect the laryngeal inlet from descending blood and secretions with a blood and secretion-tight seal above the level of the cords but below the impending surgery.
The Tulip’s benefits are clearer in ophthalmic surgery as the Patient no longer requires intubation or neuromuscular paralysis. This translates into a rapid induction and recovery anaesthetic which also reduces the coughing and straining experienced upon recovery as the Patient self-extubates when fully awake and usually requires little suctioning, which reduces stimulation still further.
The Tulip has been designed for use in day-case anaesthesia in conjunction with the rapid acting, and reflex suppressing Propofol intravenous induction agent. This agent usually allows excellent conditions for the insertion of a Tulip within 30 seconds of induction.
The grossly and morbidly obese Patients are more likely to regurgitate during anaesthesia even when fasted and are considered unsuitable candidates for Tulip usage, unless no other mechanism is suitable for airway support and control, such as the failed intubation scenario.
It has already been stated that the grossly obese are more likely to regurgitate, and that these Patients are considered unsuitable candidates for a Tulip.
The Tulip is contraindicated in non-fasted Patients and those at risk of aspiration, such as the grossly obese, those with hiatus hernia, previous opiate analgesia, those with a recent traumatic injury,
The recommended reinforced Tulip may safely be used in both the lateral and prone position by an Anaesthetist experienced in the use of a Tulip. It is important that the user is aware of the mechanisms involved in the regulation of cuff pressure.
If the situation occurs whereby the trachea cannot be intubated, it is recommended that the Patient be kept optimally oxygenated and maintained at an adequate level of anaesthesia to suppress laryngeal reflexes that may exacerbate the situation by inducing laryngeal spasm.