Nasal tracheal Intubation procedure 3

Tracheal Intubation

Follows 1V induction of anesthesia in cases of GA

Emergency intubation is another reason for Nasal intubation.

Objectives

· To ensure a clear airway for anesthetized patients.

· To protect airway from regurgitation and aspiration.

· To aid and assist in control of ventilation when muscle relaxants are used.

· To facilitate suction of respiratory tract.

· To prevent collapse of lungs in thoracic operations.

   NASAL INTUBATION is also used in cases where surgery is required in the oral cavity
   and the pharynx

Position for Laryngoscope and Intubation

· Supine.

· Flexion of the head at the neck and extension of the head at the atlanto-occipital level, the so called‘sniffing’ position.

· The head is elevated placing a low pillow or ring Oral cavity axis (OA); Pharyngeal axis (PA) and laryngeal axis (LA) are different. In this all three axis brings into alignment position and vocal cords will be viewed best with laryngoscope.

Procedure

· Awake intubation in neonates sometimes.

· Emergency awake intubation in adults when airway is compromised.

· Adequate anesthesia and muscle relaxation is the usual technique.

· After 1V or inhalational induction of anesthesia, short acting depolarizing muscle relaxant, Suxamethonium (Scoline) (! To 1.5 mg/kg) or non-depolarising relaxant 1V given.

· Assited ventilation is maintained via mask with 100% O_{2 or} with 50% N₂O in Oxygen till the muscle relaxation occurs and then tracheal intubation is performed.

· Handle of the laryngoscope held in the left hand.

· The laryngoscope blade is inserted between the teeth at the right side of the mouth and the tongue is displaced on the left side.

· The blade is advanced until the epiglottis comes into view and then lifts it upwards.

· The vocal cords will b identified. If they are not seen, an assistant is asked to push downward on the larynx.
In oral surgery the pharynx needs to be packed with  ribbon gauge to prevent aspiration
of blood. 

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