Dr.

Muhamad Haris
House Surgeon,
Surgical Unit 2, JHL

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 OBJECTIVES

what is endotracheal intubation?

what are the indications of intubation?
equipment required for intubation
technique of intubation
confirmation of intubation
ventilation
complications
extubation

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 Jawprotrusion
Neck movement
Thyromental distance
Modified Mallampati test

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 Endotracheal intubation is the placement of
a special tube in trachea

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 To secure airway
Respiratory rate<8bpm or
>35bpm
general Anesthesia
Inability to tolerate NIV
ventilatory therapy in ICU

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 size of tube
1) 0-1 yrs. 2.5 to 3.5 mm ( plain )
2) 1-3 yrs. 4. to 5 mm
3) 4-6 yrs. 5 to 6 mm
4) 6-10 yrs. 6 to 7 mm ( cuffed )
5) adult female. 7 to 8 mm
6) adult male. 8 to 9 mm
Laryngoscope
Stylet
Stethoscope
syringe
source for ventilation
Running Suction

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Different sizes of cuffed and plain ETT

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Laryngoscope

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Syringe to inflate cuff

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suction

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Raise the head by 5cm with a block or ring pillow

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 Extension at atlanto-occipital joint
Flexion at neck

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 hold the laryngoscpoe with LEFT hand
irrespective of dominant hand
open the mouth with right hand index finger with
support of thumb
introduce Laryngoscpoe from right angle of
mouth
shift the tongue to left
go in
press over tongue
see epigllotis
lift t
watch for voccal cords

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 take the tube in right hand
introduce under vision
confirm placement by auscultation
if tube is cuffed inflate the cuff with syringe

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 Confirmation
a) by chest expansion
b) by Auscultation
c) end tidal CO2/ Capnograph
d) CXR

fix the tube with adhesive

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 ambu's bag
anesthesia machine
ventilator

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- Tachycardia
- rise in blood pressure
- Increase in secretions
- Laryngospasm
- bronchospasm

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 tube in oesophagous
endobronchial intubation
trauma to teeth, pharynx and larynx
Bleeding
Disconnection, blockage, kinking of tube
Delayed Infection or tracheal stenosis

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 if mouth opening restricted
anterior vocal cords
burn contracture
Webbed neck
Morbid obesity
Cervical spine injury

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 Continue Bag Mask ventilation
Repositioning
Change of blade
Change of practitioner/ call for help
LMA
Fiberoptic intubating bronchoscope

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Laryngeal mask airway (LMA)

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It is advisable if the cause is treated
throat suction
Reflexes
Spo2
adequate respiration/ coughing
level of consciousness
Satisfactory gas exchange
extubate

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