1- For supporting ventilation in patient with some pathologic disease as:- : Upper airway obstruction : Respiratory failure : Loss of conciousness.

1- For supporting ventilation in patien t with some pathologic disease as-:

: U pper airway obstruction

: Respi rat ory failure : L oss of con

ciousness

2- For supporting ventilatio n during general anesthesia

Type of surgery

: Operative site near the airway

: Abdominal or th oracic surgery

: Prone or lateral position

: Long period of surgery

Patient has risk of p ulmonary aspiration Difficult mask ventilation

ANATOMY OF AIRWAY

--- : Congenital anomalies > Pie rre Robin syndrome , Down’s s

yndrome -- : Infection in airway > Retrop

haryngeal abscess, Epiglottitis

: Tumor in oral cavity or larynx

1 ) Condition that associated with difficult intubation

: Enlarge thyr oid gland

trachea shift to lateral or c

ompressed tr acheal lumen

1) Condition that associated withddddddddd dddddddddd (con’t)

: Maxillofacial ,cervical or laryngea l trauma

: Temperomandibular joint dysfunction

: Burn scar at face and neck

: Morbidly obese or pregnancy

1) Condition that associated withddddddddd dddddddddd (con’t)

2) - Interincisor gap : normal > more than3 cms

Soft palate

Uvula

3) Mallampati classification: Class 3,4 -> may be difficult intubation

Laryngoscopic view

grade 3,4 -> risk for difficult intubation

4) Thyromental distance : more tha n5 cms

6) Flexion and extension of neck

7) Movement of temperomandib ular joint (TMJ)

Grinding

1) Laryngoscope : handle and blade

Macintosh (curved) and Miller (straight)blade

Adult : Macintosh blade, small children : Miller blade

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Macintosh blade

2) Endotracheal tube

1) Size of endotracheal tube : indddddd dddd dddd ddd d

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 > 6 yrs : ID = (Age/4) + 4.5

3) Endotracheal tube cuff

High volume Low pressure cuff

Low volume High pressure cuff

2) Material : Red rubber or PVC

4) Bevel 5) Murphy’s eye

6) Depth of endotracheal tube : Midtrachea or below vocal cord ~ 2

cms Adult -> Male = 23 cms ,Female = 21

cms Children Oral endotracheal tube = (Age/2) +

12 (cm) Nasal endotracheal tube = (Age/2) +

15 (cm)

7) dddd d ddddddd

A. Z-79B. Disposible (Do not reuse)C. Oral/ NasalD. Radiopaque marker

3.1 Stylet

4) Oropharyngeal or nasopharyngeal airway

Oral airway Nasal airway

5) Suction catheter 6) Slip joint

6) dddd d ddd ddd dddd ddddddddd ddd

7) Magill forcep

8) Syringe9) Lubricating jelly10) Plaster for strap endotracheal tube4. Monitoring success of endotracheal intubation4.1) Stethoscope4.2) Endtidal - CO2 4.3) Pulse oximeter

Flexion at lower cervicalspine

-Extension at atlanto occi pital joint

Vareculla

Advantage 1) Comfortable for prolong int

ubation in postoperative period

2) Suitable for oral surgery : to nsillectomy , mandible surgery

3 ) For blind nasal intubation 4) Can take oral feeding 5) Resist for kinking and difficu

dd dd dddddddddd dddddddddd

1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong i

ddddddddd 3) Risk for bacteremia 4) Smaller diameter than oral

-d ddddddddd ddd ddddddd>

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

1) During intubation :Traumato l i p,tongue or teeth : Hypertension and tachycardi

a or arrhythmia : Pulmonary aspiration : Laryngospasm : Bronchospasm

1) During intubation : Laryngeal edema : A - rytenoid dislocation > h

oarseness : Increased intracranial pre

ssure : Spinal cord trauma in cer

vical spine injury : Esophageal intubation

: Obstruction from klinking , secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit

2) During remained intubation

2) During remained intubation

: Pulmonary aspiration : Lip or nasal ulcer in case with p

rolong period of intubation : Sinusitis or otitis in case with p

rolong nasoendotracheal intubation

3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway

4) After extubation

Sore throat Hoarseness Tracheal

stenosis (Prolong intubation)

Laryngeal granuloma