Friday, September 6, 2013

Anesthesia 7 Tracheal Intubation Objectives Procedure steps



 

Tracheal Intubation

Follows 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 Laryngoscopy 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 laryngoscopy.

Procedure

1.   Awake intubation in neonates sometimes.

2.   Emergency awake intubation in adults when airway is compromised.

3.   Adequate anesthesia and muscle relaxation is the usual technique.

4.   After IV or inhalational induction of anesthesia, short acting depolarising muscle relaxant, Suxamethonium (Scoline)
(1 to 1.5 mg/kg) or non-depolarising relaxant IV given.

5.   Assisted 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.

6.   Handle of the laryngoscope held in the left hand.

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

8.  The blade is advanced until the epiglottis comes into view and then lift it upwards.

9.   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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