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 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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 Endotracheal intubation is the placement of
a special tube in trachea

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1) Failure to maintain airway tone
➢ Swelling of upper airway as in anaphylaxis or
infection
2) Decreased consciousness and loss of
airway reflexes
 Failure to protect airway against aspiration -
Decreased consciousness that leads to regurgitation
of vomit, secretions, or blood
• Total upper airway
obstruction, which
requires a surgical airway
• Total loss of
facial/oropharyngeal
landmarks, which requires
a surgical airway
 size of endotracheal 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
 Bougie
 magill's forceps
 Stethoscope
 syringe
 source for ventilation
 suction
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Laryngoscope

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Magill’s forceps ( different sizes)

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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
 Introduce
Laryngoscpoe from
right angle of mouth

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 shift the tongue to
left go in press over
tongue see
epiglottis lift it
watch for voccal
cords

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 take the tube
in right hand
 introduce
under vision

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 Then inflate
the cuff with
syringe

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connection to ventilate with
 ambu's bag
 anesthesia machine
 ventilator

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 confirmation
a) by auscultation : equal air entry
b) by chest expansion
d) Capnometer: End tidal CO2

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 confirmation
a) by auscultation : equal air entry
b) by chest expansion
d) Capnometer: End tidal CO2

Capnometer:
• Refers to the
measurement and
quantification of
inhaled or exhaled
CO2, concentration at
the airway opening

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 fix the tube with adhesive

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• ECG
• SPO2
• NIBP/Art-line
• Capnograph
• Naso/Orogastric tube
• CXR
• ABG Post intubation
• Maintainace of sedation & NMB
- Tachycardia
- rise in blood pressure
- Increase in secretions
- Laryngospasm
- bronchospasm

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 tube in oesophagous
 endobrocheal intubation
 trauma to lips tooth
 Bleeding
 Leak
 Trachities
 Cough
 sore throat
 barotrauma to Lungs

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 increase in supply of O2
 to give general anesthesia
 improove exhalation of C02

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It is advisable if the cause is treated
 throat suction
 Laryngoscopy
 Reflexes
 Spo2
 adequate respiration
 level of consciousness
 extubate

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Laryngeal mask airway (LMA)

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