Title: ENDOTRACHEAL INTUBATION
1ENDOTRACHEAL INTUBATION
- Thida Ua-kritdathikarn, MD.
- Department Of Anesthesiology
- Faculty of medicine, PSU
2(No Transcript)
3(No Transcript)
4Indication for endotracheal intubation
- 1) For supporting ventilation in patient with
some pathologic disease -
-
Upper airway obstruction
Respiratory failure
Loss of conciousness
5Indication for endotracheal intubation (cont)
- 2) For supporting ventilation during general
anesthesia -
Operative site near the airway
- Abdominal or thoracic surgery
6Indication for endotracheal intubation (cont)
Prone or lateral position
Long period of surgery
- Patient has risk of pulmonary aspiration
- Difficult mask ventilation
7(No Transcript)
8AIRWAY 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
9AIRWAY ASSESSMENT
- 1) Condition that associated with difficult
intubation (cont)
- Enlarge thyroid gland
- trachea shift to lateral or compressed tracheal
lumen
10AIRWAY 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
11AIRWAY ASSESSMENT
- 2) Interincisor gap normal -gt more than 3 cms
12AIRWAY ASSESSMENT
- 3) Mallampati classification Class 3,4 -gt may be
difficult intubation
13AIRWAY ASSESSMENT
Laryngoscopic view
- grade 3,4 -gt risk for difficult intubation
14AIRWAY ASSESSMENT
- 4) Thyromental distance more than 6 cms
15AIRWAY ASSESSMENT
- 5) Flexion and extension of neck
16AIRWAY ASSESSMENT
- 6) Movement of temperomandibular joint (TMJ)
Grinding
17Equipment preparation
18- 1) Laryngoscope handle and blade
19LARYNGOSCOPIC BLADE
- Macintosh (curved) and Miller (straight) blade
- Adult Macintosh blade, small children Miller
blade
20 21Endotracheal 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
22- 2) Material Red rubber or PVC
- 3) Endotracheal tube cuff
23 24- 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)
25- 7) Tube markings
- Z-79
- Disposible (Do not reuse)
- Oral/ Nasal
- Radiopaque marker
263) Other equipments
27- 3.2 Oropharyngeal or nasopharyngeal airway
28- 3.3) Suction catheter
- 3.4) Slip joint
29- 3.5) Face mask and self inflating bag
- 3.6) Magill forcep
30- 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
31Sniffing position
- Flexion at lower cervical spine
- Extension at atlanto-occipital joint
32Sniffing position
33Steps of oroendotracheal intubation
34Steps of oroendotracheal intubation
35Steps of oroendotracheal intubation
Vareculla
36Steps of oroendotracheal intubation
37Steps of oroendotracheal intubation
38Nasoendotracheal intubation
39Nasoendotracheal 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
40Disadvantage
- 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
41Contraindication for nasoendotracheal intubation
- 1) Fracture base of skull
- 2) Coagulopathy
- 3) Nasal cavity obstruction
- 4) Retropharyngeal abscess
42Complication of endotracheal intubation
- 1) During intubation
- Trauma to lip, tongue or teeth
- Hypertension and tachycardia or arrhythmia
- Pulmonary aspiration
- Laryngospasm
- Bronchospasm
43Complication 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
44Complication 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
45Complication 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
46Complication of endotracheal intubation(Cont)
- 3) During extubation
- Laryngospasm
- Pulmonary aspiration
- Edema of upper airway
47Complication of endotracheal intubation(Cont)
- 4) After extubation
- Sore throat
- Hoarseness
- Tracheal stenosis (Prolong intubation)
- Laryngeal granuloma