Laryngotracheal Anesthesia Using the MADgic Wand

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Laryngotracheal AnesthesiaUsing the MADgic Wand
By Wolfe Tory Medical, Inc
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MADgic Wand what is it?

• It is a MADgic embedded into a tissue retractor
  to make delivery of topical anesthetics easier

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MADgic Wand Features

• Features
• Tissue retractor shaped like laryngoscope with
  MADgic atomizer embedded into the product
• Allows application of topical drugs to the
  opening of the airway as well as deeply into the
  airway as the gag/sensation is depressed
• Its shape allows it to be placed blindly and
  aim the atomizer at the glottic opening
• It can be used to retract soft tissue such as the
  tongue to enhance drug delivery an important
  feature in obesity and difficult airways where
  direct visualization is very difficult

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MADgic Wand Features

• Features
• Atomizing Tip
• Converts any liquid medication into an
  approximately 60 micron sized droplet spray.
• This sized droplet comes out of the air and
  sticks to the mucosa in a thin layer where it can
  have its clinical effect.
• Droplet size and spray force are gentle,
  atraumatic

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How to use the MADgic Wand

• Step 1 Incrementally anesthetize the mouth, hard
  and soft palate, tongue and back of throat
• Step 2 After initial anesthetic takes effect,
  use the device to gently retract tongue and spray
  more anesthetic into hypopharynx slowly and
  incrementally proceed deeper until the device is
  well tolerated and you can lift the tongue/soft
  tissue and spray the glottic opening to prepare
  for instrumentation.
• Step 3 Insert instrument (OP airway, fiberoptic
  scope) and apply final doses of anesthetic to the
  vocal cords, glottic opening, etc
• Step 4 Proceed to intubation

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Step 1 precursor Draw up your medication

• Medications
• 4 lidocaine is most common for adults
• 2 lidocaine for kids
• Oxymetazoline or phenylephrine for nasal
  vasoconstriction
• Others Tetracaine, cocaine, etc

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Step 1 Anesthetize the mouth, palate and tongue
and throat
With the patient sitting slightly back or lying
down, the initial dose of lidocaine should be
gently sprayed onto the lips, hard and soft
palate and visible tongue. Allow drug to work (3
minutes)
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Step 2 Gently retract tongue/tissue and spray
more anesthetic

• Touch the back of the tongue with the device if
  this is tolerated you can proceed further (if not
  put more lidocaine on tongue)
• Incrementally apply small sprays of lidocaine
  wait repeat and advance as tolerated

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Slowly and incrementally proceed deeper until the
device is well tolerated

• Take your time, talk the patient through this

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Lift the tongue/soft tissue and spray the glottic
opening

• Ask the patient to take long slow inhalations as
  you spray small increments of drug will ensure
  delivery to vocal cords and larynx
• Once they no longer cough you know you have
  good anesthesia

Gently lift tongue
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Insert Oral-pharyngeal airway for fiber optic
procedure

• An OP airway prevents biting of the scope.
• It is not necessary if intubation without
  fiberoptics is planned.

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Step 3 Insert instrument and apply final doses
of anesthetic

• Another scenario is to insert the fiber-optic
  intubating laryngoscope and spray additional drug
  onto the cords and trachea (if needed) using the
  channel provided within the fiber-optic scope.

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Proceed to intubation

• The patient can now be intubated using whatever
  method the clinician chooses.

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Successful intubation in awake case after MADgic
applied lidocaine