Summary

In session VII you have learnt

• The most common complications resulting from intubation are trauma to the lips, teeth, pharynx and larynx caused by forceful handling or unintentional pinching of structures. Hypoxia, hypercarbia, acidosis, arrhythmia, and death can result from improper placement of the endotracheal tube.
• Advancing the endotracheal tube too far between the vocal cords, results in a mainstem bronchus intubation which needs to be corrected. Flexion of the patient's head may advance the tube up to 1 .9 c m and convert a tracheal placement into an endobronchial intubation, especially in children. The key to detecting this complication is auscultation of the lungs with a stethoscope immediately after intubation.
• Thick upper airway secretion, foreign body in ETT, herniation of ETT cuff, kinking, bevel attachment with tissue can obstruct the air way after successful intubation. You can prevent certain type of obstruction by taking precaution (checking ETT for patency and herniation) before intubation.
• Laryngospasm (the vocal cord comes together) is unlikely if the depth of anesthesia is sufficient during tracheal extubation (laryngeal reflexes suppressed) or the patient is allowed to awaken before tracheal extubation (laryngeal reflexes intact). It can be treated by oxygenation, suction and suxamethenium.
• Pulmonary aspiration is inhalation of gastric contents in to the tracheobroncheal tree. Patients undergoing emergency surgery with a full stomach, the pregnant patient, bowel obstruction, the obese patient, diabetics, and patients with gastric reflux disease are at risk for aspiration.
• A difficult airway is defined as the clinical situation in which a conventionally trained anesthetist experiences difficulty with face mask ventilation, difficulty with tracheal intubation, or both. Difficult face mask ventilation is inability maintain oxygen saturation (SaO2) >90% using 100% oxygen and positive pressure mask ventilation in a patient whose SaO2 was >90% before clinician intervention. Difficult laryngoscopy is a condition when it is not possible to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy. Difficult tracheal intubation is a condition when it requires greater than three attempts.
• Failed intubation, defined simply by a failure to intubate after three attempts(can't intubate, CAN oxygenate) , one is still dealing with an oxygenated patient, or failed oxygenation failure to intubate in conjunction with a failure to oxygenate using BMV (can't intubate, CAN'T oxygenate), a hypoxic one.
• Inability to oxygenate the patient with mask ventilation or via an endotracheal tube is an emergency situation. The default intervention for this failed oxygenation situation is LMA if that not improve the situation cricothyrotomy
• The Combitube is a twin lumen device designed for use in emergency situations and difficult airways. It can be inserted without the need for visualization into the oropharynx, and usually enters the esophagus. It has a low volume inflatable distal cuff and a much larger proximal cuff designed to occlude the oropharynx and nasopharynx.
• Suggested surgical airways for difficult airway is cricothyrotomy, needle cricothyrotomy and tracheostomy