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14. Management in positive pressure ventilation.

14. Management in positive pressure ventilation.

The Tulip has been designed to be easily introducible, with an effective ventilatory seal that operates at 60mls volume under normal circumstances. This enables manual ventilation at +/-20cmH2O normally. This enables the Tulip to be used with intermittent positive pressure ventilators when required.

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15. Emergence from Anaesthesia.

15. Emergence from Anaesthesia.

  • The Tulip is best removed in a fully staffed and equipped recovery area, which allows full monitoring and suction.
  • The Anaesthetist must check the Patient’s ventilation, and confirm a clear ventilating airway before handing over the Patient to recovery staff.
  • The Tulip is to be left in place fully-inflated when leaving theatre and it is recommended that visualized oral suction, external to the Tulip, be performed prior to leaving the operating theatre.

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16. Recovery from Anaesthesia and Removal of the Tulip;

16. Recovery from Anaesthesia and Removal of the Tulip;

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.

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17. Inspection of the Oropharynx and Upper Gastrointestinal tract.

17. Inspection of the Oropharynx and Upper Gastrointestinal tract.

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.

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19. Operations of the Head and Neck

19. Operations of the Head and Neck

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.

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20. Eye Surgery

20. Eye 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.

22. Short procedures

22. Short procedures

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.

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23. Obesity

23. Obesity

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.

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24. Unexpected Regurgitation

24. Unexpected Regurgitation

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,

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