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ENDOTRACHEAL INT UBATION Thida Ua-kritdathika rn, MD. Department Of Anesth esiology Faculty of medicine,

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Page 1: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

ENDOTRACHEAL INTUBATION

Thida Ua-kritdathikar n, MD.

Department O f Anesthesiology

Faculty of medicine, PSU

Page 2: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU
Page 3: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU
Page 4: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of 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

Page 5: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 6: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 7: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

ANATOMY OF AIRWAY

Page 8: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 9: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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)

Page 10: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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)

Page 11: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAY ASSESSMENT

- 2 3) Interincisor gap : normal > more than cmm

Page 12: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAY ASSESSMENT 3) Mallampati classification: Class

- 34, > may be difficult intubation

Sof t pal ate

Uvula

Page 13: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAYASSESSMENT

- 34grade , > risk for difficumm mmmmmmmmmm

Laryngoscopic view

Page 14: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAY ASSESSMENT

4)Thyromentaldistance:more than6cms

Page 15: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAY ASSESSMENT 5) Flexion and extension of neck

Page 16: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

AIRWAY ASSESSMENT 6) Movement of temperomandibular joint (TMJ)

Grinding

Page 17: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Equipment preparation

Page 18: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

1)Laryngoscope :handle and blade

Page 19: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

LARYNGOSCOPIC BLADE

Macintosh(curved)andMiller(strai ght)bl ade Adult : Macintosh blade, small childre

n : Miller blade

mmmmmm mmmmm

Macintosh blade

Page 20: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

2 ) Endotracheal tube

Page 21: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 22: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

3 ) Endotracheal tube cuff

High volume Low pressure cuff

Low volume High pressure cuff

2) Material : Red rubber or PVC

Page 23: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

mmmmm4

mmm5 ) ’

Page 24: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 25: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

7) Tube markings

-79Z mmm mmmmmm( ) m mmmm/ m mmmmmmmmm m mmmmm

Page 26: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

3) Other equipments

3.1Styl et

Page 27: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

32. Oropharyngeal or nasopharyngeal airway

Oral airway Nasal airway

Page 28: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

33. ) Suction catheter 34. ) Slip joint

Page 29: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

mmmm m mmm mmm mmmm mmmmm3 .5 )mmmm mmm

36. ) Magill forcep

Page 30: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 31: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Sniffing position

Flexion at lower c ervical spine

Extension at atla- nto occipital joint

Page 32: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Sniffingposition

Page 33: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Steps of oroendo tracheal intubati

on

Page 34: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Steps of oroendotracheal intubation

Page 35: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Steps of oroendotracheal intubationVareculla

Page 36: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Steps of oroendotracheal intubation

Page 37: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Steps of oroendotracheal intubation

Page 38: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Nasoendotrachea l intubation

Page 39: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 40: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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>

Page 41: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Contraindication for nasoendotrachea

l intubation 1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess

Page 42: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 43: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 44: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 45: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

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

Page 46: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway

Complication of endotra cheal intubation(Con’t)

Page 47: ENDOTRACHEAL INTUBATION Thida Ua-kritdathikarn, MD. Department Of Anesthesiology Faculty of medicine, PSU

Complication of endotra cheal intubation(Con’t)

4) After extubation

Sore throat Hoarseness Tracheal stenosis (Prolong intubation)

Laryngeal granuloma