Summary

In session VI you have learnt

• Endotracheal Intubation is the passage of a flexible plastic tube (tracheal tube) through the mouth or nose in to the trachea to maintain an open airway, to deliver anesthetic gases and allow control of ventilation and oxygenation.
• Laryngoscope is a tubular endoscope equipped with a blade and light bulb used to view the larynx and adjacent structures, most commonly for the purpose of inserting a tube into the trachea. A straight laryngoscope blade is made to pick up the epiglottis. A curved blade is made to fit into the area anterior to the epiglottis called the vallecula and indirectly expose the glottic opening.
• Tracheal tubes is a plastic flexible tube most commonly made from polyvinyl chloride and produced in different lengths and diameters for all category of patient. An adult or adolescent female will usually require a 7.0 to 7.5 sized endotracheal tube. An adult or adolescent male will usually require a 7.5 to 8.0 sized endotracheal tube. For most adults the depth is approximately 20-22 cm.
• When assembling equipment for intubation, have the following laryngoscope, appropriate size tracheal tube, Magill's forceps, suction with suction catheter, anesthesia machine or means of delivering oxygen, assistant, tape, etc.
• Positioning the patient is important to the success and ease of intubation. The neck should be slightly flexed and head extended (sniffing position) to allow for the best view of the larynx. In adults, one or two pillows or blankets should achieve this. In children, no pillow is needed. In infants it may be necessary to place a small pillow under the shoulders.
• The first step in an anesthetic induction is to pre-oxygenate the patient with 100% oxygen. This will remove nitrogen from the lungs.
• The next step is to take the laryngoscope in the left hand. Place the blade gently into the right side of the patient's mouth. Advance the blade until the uvula is visualized.
• There are objective (observing the ETT go through the cords, looking for the presence of end tidal carbon dioxide) and subjective (bilateral chest expansion and breath sounds with manual ventilation, characteristic feel of the reservoir bag, maintenance of normal PSO2 ...) means of confirming ETT location.
• Tracheal extubation after general anesthesia requires skill and judgment learned through experience. The patient must be either deeply anesthetized or fully awake at the time of tracheal extubation. Tracheal extubation during a light level of anesthesia increases the risk for laryngospasm.
• Spontaneous breathing with 100% oxygen is established before tracheal extubation. The oropharynx is suctioned just before tracheal extubation. The endotracheal tube cuff is deflated and the trachea tube rapidly removed from the patient's trachea. and upper airway while a positive-pressure breath is delivered to help expel any secretions.