ENDOTRACHEAL INTUBATION
Thida Ua-kritdathikar n, MD.
Department O f Anesthesiology
Faculty of medicine, PSU
Indication for endot racheal intubation 1) For supporting ventilation in patient with so
mm mmmmmmmmmm mmmmmmm
: U pper airway obstruction
: Respirat ory failure : L oss of co
nciousness
Indication for endotrach eal intubation (con’t)
2) For supporting ventilation during gemmmmm mmmmmmmmmm
Type of surgery
: Operative site near the airway
: Abdominal or th oracic surgery
Indication for endotrach eal intubation (con’t)
: Prone or lateral position
: Long period of surgery
Patient has risk of p ulmonary aspiration Difficult mask ventilation
ANATOMY OF AIRWAY
AIRWAY ASSESSMENTS
--- :Congenitalanomalies >Pi erre Robi nsyndrome ,Dow n’ssyndrome
-- : Infection in airway > Retroph aryngeal abscess, Epiglottitis
: Tumor in oral cavity or larynx
1 ) Condition that associate d with difficult intubation
AIRWAY ASSESSMENT
: Enl arge thyroi dgl and
trachea shi f t to l ateral or compre
ssedtracheal l umen
1) Condition that associated witm mmmmmmmmm mmmmmmmmmm (con’t)
AIRWAY ASSESSMENT
: Maxillofacial ,cervical or laryngea l trauma
: Temperomandibular joint dysfunction
: Burn scar at face and neck
: Morbidly obese or pregnancy
1) Condition that associated withmmmmmmmmm mmmmmmmmmm (con’t)
AIRWAY ASSESSMENT
- 2 3) Interincisor gap : normal > more than cmm
AIRWAY ASSESSMENT 3) Mallampati classification: Class
- 34, > may be difficult intubation
Sof t pal ate
Uvula
AIRWAYASSESSMENT
- 34grade , > risk for difficumm mmmmmmmmmm
Laryngoscopic view
AIRWAY ASSESSMENT
4)Thyromentaldistance:more than6cms
AIRWAY ASSESSMENT 5) Flexion and extension of neck
AIRWAY ASSESSMENT 6) Movement of temperomandibular joint (TMJ)
Grinding
Equipment preparation
1)Laryngoscope :handle and blade
LARYNGOSCOPIC BLADE
Macintosh(curved)andMiller(strai ght)bl ade Adult : Macintosh blade, small childre
n : Miller blade
mmmmmm mmmmm
Macintosh blade
2 ) Endotracheal tube
Endotracheal tube
80 75Male: ID . mms . Female : ID .mmm
- mm m mm m m m3 : 3 . 0 - 3 9 : 3 .5months ID mms - 918 40months : ID . mms - mm m 2 6 : = (/3) 35+ . mm m > 6 : = (4Age/ ) 45
1) Size of endotracheal tubem mmmmmmmm mmmm mmmm mmm m
3 ) Endotracheal tube cuff
High volume Low pressure cuff
Low volume High pressure cuff
2) Material : Red rubber or PVC
mmmmm4
mmm5 ) ’
6) Depth of endotracheal tube : Midtr mmmmm mmmmm mmmm m m mm m~ 2
- mm > = 2 3 , = 2 1mm m
mmmmmmmm
mmmm mmmmmmmmmmmm mmmm = ( 2Age/ ) + 12 (cm)
mmmmmmmmmmmm mmmm m = ( 2Age/ ) + 1 5 ( )cm
7) Tube markings
-79Z mmm mmmmmm( ) m mmmm/ m mmmmmmmmm m mmmmm
3) Other equipments
3.1Styl et
32. Oropharyngeal or nasopharyngeal airway
Oral airway Nasal airway
33. ) Suction catheter 34. ) Slip joint
mmmm m mmm mmm mmmm mmmmm3 .5 )mmmm mmm
36. ) Magill forcep
37. ) Syringe 38. ) Lubricating jelly 39. ) Plaster for strap endotra
mmmmm mmmm 4. Monitoring success of en
mmmmmmmmmm mmmmmmmmmm 4.1) Stethoscope - 42. ) Endtidal CO
2
43. ) Pulse oximeter
Sniffing position
Flexion at lower c ervical spine
Extension at atla- nto occipital joint
Sniffingposition
Steps of oroendo tracheal intubati
on
Steps of oroendotracheal intubation
Steps of oroendotracheal intubationVareculla
Steps of oroendotracheal intubation
Steps of oroendotracheal intubation
Nasoendotrachea l intubation
Nasoendotrachea l intubation
Advantage 1) Comfortable for prolong intub
mmmmm mm mmmmmmmmmmmmm mmmmmm 2) :Suitable for oral surgery tonsill
m mmmmmmmm mmmmmmm, 3) For blind nasal intubation 4) Can take oral feeding 5) Resist for kinking and difficult t
o acci dent al ext ubat i on
Disadvantage 1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong
mmmmmmmmmm 3) Risk for bacteremia 4) Smaller diameter than oral
-m mmmmmmmmm mmm mmmmmmm>
Contraindication for nasoendotrachea
l intubation 1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess
Complication of endot racheal intubation
1) During intubation :Traumato l i p,tongue or teeth :Hypertensi onandtachycardi
a or arrhythmi a :Pul monary aspi rati on :Laryngospasm :Bronchospasm
Complication of endotra cheal intubation (Con’t)
1) During intubation mmmmmmmmm mmmmm:
: A - rytenoiddi sl ocat i on >hoar seness : Increased intracranial pressure : Spinal cord trauma in cervical s
mmmm mmmmmm : Esophageal intubation
Complication of endotra cheal intubation(Con’t)
: Obstruction from klinking , secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit
2) During remained intubation
Complication of endotra cheal intubation(Con’t)
2) During remained intubation
: Pulmonary aspiration : Lib or nasal ulcer in case with
prolong period of intubation : Sinusitis or otitis in case with
prolong nasoendotracheal intubation
3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway
Complication of endotra cheal intubation(Con’t)
Complication of endotra cheal intubation(Con’t)
4) After extubation
Sore throat Hoarseness Tracheal stenosis (Prolong intubation)
Laryngeal granuloma
