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Airway Management and Intubation Guide

This document discusses endotracheal intubation, including indications, anatomy, equipment, techniques, complications, and monitoring. It describes how endotracheal intubation is used to support ventilation in patients with upper airway obstruction, respiratory failure, or who require general anesthesia. Key anatomy that can affect intubation like mouth opening, neck mobility, and laryngeal view are outlined. Equipment for intubation including laryngoscopes, endotracheal tubes, stylets, airways, and monitoring devices are also reviewed. Potential complications from intubation, during intubation, during ventilation, during extubation, and after extubation are listed.

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Gusti Ngurah Andhika P
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171 views45 pages

Airway Management and Intubation Guide

This document discusses endotracheal intubation, including indications, anatomy, equipment, techniques, complications, and monitoring. It describes how endotracheal intubation is used to support ventilation in patients with upper airway obstruction, respiratory failure, or who require general anesthesia. Key anatomy that can affect intubation like mouth opening, neck mobility, and laryngeal view are outlined. Equipment for intubation including laryngoscopes, endotracheal tubes, stylets, airways, and monitoring devices are also reviewed. Potential complications from intubation, during intubation, during ventilation, during extubation, and after extubation are listed.

Uploaded by

Gusti Ngurah Andhika P
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

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1) For

supporting ventilation in patient with some pathologic disease

: Upper airway obstruction

: Respiratory failure : Loss of conciousness


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For supporting ventilation during general anesthesia

Type of surgery

: Operative site near the airway


: Abdominal or thoracic surgery

: Prone or lateral position

: Long period of surgery


Patient has risk of pulmonary aspiration
Difficult mask ventilation

ANATOMY OF AIRWAY

1) Condition that associated with difficult intubation


: Congenital anomalies ---> Pierre Robin syndrome , Downs syndrome : Infection in airway--> Retropharyngeal abscess, Epiglottitis : Tumor in oral cavity or larynx

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

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


Soft palate

Uvula

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Laryngoscopic view

grade 3,4 -> risk for difficult intubation


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4) Thyromental distance : more than 6 cms

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5) Flexion and extension of neck

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6) Movement of temperomandibular joint (TMJ)

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1) Laryngoscope : handle and blade

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Macintosh (curved) and Miller (straight)

blade Adult : Macintosh blade, small children : Miller blade

Miller blade

Macintosh blade
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2) Endotracheal tube

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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 > 6 yrs : ID =
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2) Material : Red rubber or PVC 3) Endotracheal tube cuff

High volume Low pressure cuff

Low volume High pressure 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 -> 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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3.1 Stylet

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3.2 Oropharyngeal or nasopharyngeal airway

Oral airway

Nasal 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 4.1) Stethoscope 4.2) Endtidal - CO2 4.3) Pulse oximeter

4. Monitoring success of endotracheal intubation

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Vareculla

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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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1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong intubation 3) Risk for bacteremia 4) Smaller diameter than oral route -> difficult for suction
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1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess

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1) During intubation
: Trauma to lip, tongue or teeth : Hypertension and tachycardia or arrhythmia : Pulmonary aspiration : Laryngospasm : Bronchospasm
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1) During intubation : Laryngeal edema : Arytenoid dislocation -> hoarseness : Increased intracranial pressure : Spinal cord trauma in cervical spine injury : Esophageal intubation

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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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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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3) During extubation
Laryngospasm

Pulmonary aspiration Edema of upper airway

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4) After extubation
Sore throat

Hoarseness Tracheal stenosis (Prolong intubation) Laryngeal granuloma


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