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.
(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.
Any questions be sent to drmmkapur@gmail.com
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