The Tulip’s role in emergency and resuscitation medicine is based upon its ability to be introduced easily, effectively and quickly by a wide range of healthcare staff. The Tulip’s ability to fit all adults with one size enables fewer to be carried by medical staff who quickly become familiar with its common, wide-ranging use.
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, massive or multiple injury, those of greater than 14 weeks gestation, those with an autonomic neuropathy and those with an acute abdomen, reduced gastric emptying or dilation of the stomach.
The Tulip is a single use, disposable item, and must never be autoclaved for re-use. The Tulip is a contaminated item after use and must be disposed of in the recommended fashion.
The Tulip is designed to be easily introducible without the need to perform any form of visualization. The single adult size is designed to fit a majority of adults who lie within the considered normal range by virtue of an anatomical inflatable cuff which expands to form an oropharyngeal seal between the soft palate, the epiglottis and oropharyngeal walls.
Dr. A. Shaikh
Introduction
The historical article on the development by Dr Brain of the laryngeal mask airway [1] shows for the first time what the processes were for the introduction of a new airway device some 30 years ago. The authors of the paper state that it would be ‘interesting to speculate whether such research would be possible under today’s more stringent conditions’.
Manikin evaluation of the Tulip – a new supraglottic airway
Anaesthesia, 2009, 64, pages 793–813
S. Harrison,1 N. P. Robinson,2 A. Shaikh3 and S. M. Yentis4
What it’s about:
3 operators inserted 3 devices (LMA, iGel, Tulip) in manikins.
Each device inserted 3 times in total.
Historically, the publications show that Laryngeal Masks have a higher incidence of methylene blue dye regurgitation than Guedel airways when used with Facemasks in live patients. This seems counter-intuitive but when a capsule of blue dye is ingested by the patient 10 minutes before induction and the airway is visualized after the end of surgery in patients at no known risk of regurgitation Barker P states “Dye was observed within the Laryngeal Mask in 7 of 28 patients (25%). No patients in the Facemask-Guedel airway group regurgitated dye (p=0.005)”.
Clearing and maintaining an airway is one of the first priorities for emergency personnel called to an out of hospital cardiac arrest, and many are trained to intubate or place supraglottic devices such as a laryngeal mask airway. Evidence has begun to emerge that these advanced techniques may do more harm than good in the prehospital setting.
by rfdsdoc on September 21, 2012
This months anaesthesia journal reading revealed this gem from German authors.
In a cadaver model of simulated complete airway obstruction, ventilation pressures of 20mBar did not produce any oesophageal insufflation in any of the 4 supraglottic airways but at higher presssures 40mBar and greater, there was air leak into the oesophagus and this was more so in the laryngeal tube airway devices. iGel and LMA Supreme devices performed well.
Dear Editor,
New anaesthetic equipment and it’s pathway to introduction has been a topic of discussion over the past few years and this is a conversation in which we have participated. The ADEPT recommendations were noted to reflect the processes through which the Tulip airway had been developed, tested and researched ultimately producing level 1 evidence with a randomized controlled trial being submitted to Anaesthesia in December 2014 for consideration.