ENDOTRACHEAL INTUBATION - PowerPoint PPT Presentation

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ENDOTRACHEAL INTUBATION

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Congenital anomalies --- Pierre Robin syndrome , Down's syndrome : ... 1) Laryngoscope : handle and blade. LARYNGOSCOPIC BLADE ... – PowerPoint PPT presentation

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Title: ENDOTRACHEAL INTUBATION


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

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Indication for endotracheal intubation
  • 1) For supporting ventilation in patient with
    some pathologic disease

Upper airway obstruction
Respiratory failure
Loss of conciousness
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Indication for endotracheal intubation (cont)
  • 2) For supporting ventilation during general
    anesthesia
  • Type of surgery

Operative site near the airway
  • Abdominal or thoracic surgery

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Indication for endotracheal intubation (cont)
Prone or lateral position
Long period of surgery
  • Patient has risk of pulmonary aspiration
  • Difficult mask ventilation

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AIRWAY ASSESSMENTS
  • 1) Condition that associated with difficult
    intubation
  • Congenital anomalies ---gt Pierre Robin syndrome
    , Downs syndrome
  • Infection in airway--gt Retropharyngeal abscess,
    Epiglottitis
  • Tumor in oral cavity or larynx

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AIRWAY ASSESSMENT
  • 1) Condition that associated with difficult
    intubation (cont)
  • Enlarge thyroid gland
  • trachea shift to lateral or compressed tracheal
    lumen

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AIRWAY ASSESSMENT
1) Condition that associated with difficult
intubation (cont)
  • Maxillofacial ,cervical or laryngeal trauma
  • Temperomandibular joint dysfunction
  • Burn scar at face and neck
  • Morbidly obese or pregnancy

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AIRWAY ASSESSMENT
  • 2) Interincisor gap normal -gt more than 3 cms

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AIRWAY ASSESSMENT
  • 3) Mallampati classification Class 3,4 -gt may be
    difficult intubation

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AIRWAY ASSESSMENT
Laryngoscopic view
  • grade 3,4 -gt risk for difficult intubation

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AIRWAY ASSESSMENT
  • 4) Thyromental distance more than 6 cms

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AIRWAY ASSESSMENT
  • 5) Flexion and extension of neck

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AIRWAY ASSESSMENT
  • 6) Movement of temperomandibular joint (TMJ)

Grinding
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Equipment preparation
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  • 1) Laryngoscope handle and blade

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LARYNGOSCOPIC BLADE
  • Macintosh (curved) and Miller (straight) blade
  • Adult Macintosh blade, small children Miller
    blade

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  • 2) Endotracheal tube

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Endotracheal tube
  • 1) Size of endotracheal tube internal diameter
    (ID)
  • Male ID 8.0 mms . Female ID 7.5 mms
  • New born - 3 months ID 3.0 mms
  • 3-9 months ID 3.5 mms
  • 9-18 months ID 4.0 mms
  • 2- 6 yrs ID (Age/3)
    3.5
  • gt 6 yrs ID (Age/4)
    4.5

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  • 2) Material Red rubber or PVC
  • 3) Endotracheal tube cuff

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  • 4) Bevel
  • 5) Murphys eye

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  • 6) Depth of endotracheal tube Midtrachea or
    below vocal cord 2 cms
  • Adult -gt Male 23 cms ,Female 21 cms
  • Children

  • Oral endotracheal tube (Age/2) 12
    (cm)
  • Nasal endotracheal tube (Age/2) 15 (cm)

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  • 7) Tube markings
  • Z-79
  • Disposible (Do not reuse)
  • Oral/ Nasal
  • Radiopaque marker

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3) Other equipments
  • 3.1 Stylet

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  • 3.2 Oropharyngeal or nasopharyngeal airway

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  • 3.3) Suction catheter
  • 3.4) Slip joint

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  • 3.5) Face mask and self inflating bag
  • 3.6) Magill forcep

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  • 3.7) Syringe
  • 3.8) Lubricating jelly
  • 3.9) Plaster for strap endotracheal tube
  • 4. Monitoring success of endotracheal intubation
  • 4.1) Stethoscope
  • 4.2) Endtidal - CO2
  • 4.3) Pulse oximeter

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Sniffing position
  • Flexion at lower cervical spine
  • Extension at atlanto-occipital joint

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Sniffing position
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Steps of oroendotracheal intubation
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Steps of oroendotracheal intubation
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Steps of oroendotracheal intubation
Vareculla
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Steps of oroendotracheal intubation
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Steps of oroendotracheal intubation
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Nasoendotracheal intubation
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Nasoendotracheal intubation
  • Advantage
  • 1) Comfortable for prolong intubation in
    postoperative period
  • 2) Suitable for oral surgery tonsillectomy ,
    mandible surgery
  • 3) For blind nasal intubation
  • 4) Can take oral feeding
  • 5) Resist for kinking and difficult to accidental
    extubation

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Disadvantage
  • 1) Trauma to nasal mucosa
  • 2) Risk for sinusitis in prolong intubation
  • 3) Risk for bacteremia
  • 4) Smaller diameter than oral route -gt difficult
    for suction

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Contraindication for nasoendotracheal intubation
  • 1) Fracture base of skull
  • 2) Coagulopathy
  • 3) Nasal cavity obstruction
  • 4) Retropharyngeal abscess

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Complication of endotracheal intubation
  • 1) During intubation
  • Trauma to lip, tongue or teeth
  • Hypertension and tachycardia or arrhythmia
  • Pulmonary aspiration
  • Laryngospasm
  • Bronchospasm

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Complication of endotracheal intubation (Cont)
  • 1) During intubation
  • Laryngeal edema
  • Arytenoid dislocation -gt hoarseness
  • Increased intracranial pressure
  • Spinal cord trauma in cervical spine injury
  • Esophageal intubation

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Complication of endotracheal intubation(Cont)
2) During remained intubation
Obstruction from klinking , secretion or
overinflation of cuff Accidental extubation
or endobronchial intubation Disconnection
from breathing circuit
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Complication of endotracheal intubation(Cont)
  • 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

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Complication of endotracheal intubation(Cont)
  • 3) During extubation
  • Laryngospasm
  • Pulmonary aspiration
  • Edema of upper airway

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Complication of endotracheal intubation(Cont)
  • 4) After extubation
  • Sore throat
  • Hoarseness
  • Tracheal stenosis (Prolong intubation)
  • Laryngeal granuloma
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