Tracheal Intubation
Follows 1V induction of anesthesia.
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.
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% O2 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 be identified.
If they are not seen, an assistant is asked to push downward on the larynx.
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