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

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