NVA®
NASAL VESTIBULE AIRWAY
INTENDED USE:
The NVA® is a pressure sealing, self-retaining nasal cannula indicated for use with an anesthesia circuit to deliver a precise concentration of oxygen under low pressure to the upper airway of the anesthetized patient. Used properly, the NVA helps preserve spontaneous respiration by preventing the upper
airway obstruction that tends to occur as anesthetic sedation progresses from mild through moderate to deep levels.
WARNINGS:
- The NVA® should only be used by or under the direction of a physician skilled in airway management. The physician should have a thorough understanding of the prevention of CO2 retention in an anesthesia circuit. Also essential, is a thorough understanding of the pathophysiology of the upper airway obstruction which is common to both Obstructive Sleep Apnea (OSA) and the Syndrome of Narcogenic Obstructive Respiration
(SNOR) which is drug-induced and accompanied by depression of the rescuing reflexes that are active in OSA.
- In order to prevent the rebreathing of
carbon dioxide, the NVA® should be used only with ANESTHESIA breathing circuits and NOT with non-vented CPAP tubing.
- Depending on the particular application of the NVA®, usually it will be necessary to monitor end-tidal CO2 at the mouth.
End-tidal CO2, thus detected, will monitor respiratory rate but should not be taken as a reflection of arterial pCO2.
- In order to monitor respirations and breathing circuit pressures, it is recommended that the NVA® be used in conjunction with a circuit pressure gauge.
- In order to detect the inspiratory stridor that signals upper airway obstruction, it is recommended that the NVA® be used in conjunction with a SNOR-SCOPE® circuit stethoscope or with a supra-sternal stethoscope.
- In order to prevent dangerous oxygen enrichment of the surgical field when electro-cautery or LASER is in use, the inspired oxygen concentration must be monitored continuously and regulated to less than 30% oxygen in air ( NOT nitrous oxide ) after the induction of anesthesia and well before initiating electro-cautery or LASER.
- The NVA® should not be used in acute trauma of the nose. Such use might potentially cause insufflation of gas through disrupted anatomical barriers.
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CAUTIONS:
- Appropriate steps should be taken to keep the NVA® clean when sizing and handling prior to insertion.
- If to be left exposed within the surgical field, the NVA® should be as thoroughly prepped as the skin.
- A clear adhesive dressing ( e.g., TEGADERM® ) may be used to stabilize and to better seal the nasal insert.
If so used, the dressing should NOT be stretched so as to avoid tension and ischemia of the skin of the nose.
- While it has not yet been observed to be a problem, the use of an NVA® in a patient with sinusitis or otitis media requires the exercise of good judgment as to the relative risk / benefit ratio when compared to other modes of airway management.
SNOR-SCOPE®
INTENDED USE:
The SNOR-SCOPE® is a stethoscope head in a T-connector to be used inline with an anesthesia circuit. It is indicated to monitor the sounds of gas flow within an anesthesia circuit. The
SNOR-SCOPE® is especially useful in the early detection of the stridor caused by partial obstruction of the upper airway. The SNOR-SCOPE® is joined to the tubing of the user's own stethoscope by an appropriately-sized 15mm endotracheal tube connector ( not supplied ) .
WARNING:
The diaphragm of the stethoscope is made of a tough, but thin, sheet of plastic. It is possible, but not likely, that this diaphragm might rupture and cause an anesthesia circuit leak. This occurrence should be detectable by a routine pressure check of the breathing circuit and by listening for a leak over the connecting port of the stethoscope.
CAUTION:
The SNOR-SCOPE® is a reliable monitor to detect an evolving obstruction of the upper airway. Detection of stridor should trigger the early adjustment of flow rates and pressure within the breathing circuit until airway obstruction and its telltale stridor is eliminated.
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