EQUIPMENT OF INTUBATION لينا محمد بزبز

The following is a list of the basic needs for intubation. • Laryngoscope. • Tracheal tubes. • An oxygen source • Other (not ETT) airway devices (nasal, supraglottic airways) • Pulse oximetry and CO2 detection • Stethoscope • Blood pressure and electrocardiography (ECG) monitors • Intravenous access

Laryngoscope 1-Laryngoscopy is endoscopy of the Larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal fold and the glottis. Laryngoscopy may be performed to facilitate ETT during General Anasthesia 1-Laryngoscopyis endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during general anaesthesia 2-The Macintosh blade is positioned in the vallecula, anterior to the epiglottis, lifting it out of the visual pathway, while the Miller blade is positioned posterior to the epiglottis, trapping it while exposing the glottis and vocal folds. Incorrect usage can cause trauma to the front incisors consists of a handle containing batteries with a light source , and a set of interchangeable blades

Laryngoscope The Straight blade 2) The curved blade There are two basic type of blades The Straight blade (e. miller) is favored for children and are designed to pass posterior to the epiglottis. 2) The curved blade (e.g. Macintosh) is designed so that the tip lies anterior to the epiglottis . Incorrect usage can cause trauma to the front incisors

Laryngoscope The choice of blade depends on personal preference and patient anatomy. Because no blade is perfect for all situations, the clinician should become familiar and proficient with a variety of blade designs Both Miller and Macintosh laryngoscope blades are available in sizes 0 (neonatal) through 4 (large adult). The Miller blades are commonly used for infants. It is easier to visualize the glottis using these blades than the Macintosh blade in infants, due to the larger size of the epiglottis relative to that of the glottis May 19

Video laryngoscope

Endotracheal Tube Endotracheal intubation is employed both for the conduct of general anesthesia and to facilitate the ventilator management of the critically ill. Most of endotracheal tubes made of either rubber or PVC(polymerized vinyl chloride which is a synthetic resin).

size SIZE The size quoted usually is the internal diameter. ORAL INTUBATION The size of the tube The size quoted usually is the internal diameter. Resistance to airflow depends primarily on tube diameter, but is also affected by tube length and curvature choice of tube diameter is always a compromise between maximizing flow with a larger size and minimizing airway trauma with a smaller size Cut Length(cm) Internal Diameter(mm) Age 12 3.5 Full-term infant 4 + Age/2 4 +Age/4 child 24 7.0 -7.5 7.5 -9.0 Adult Female Male

**In order to seal airway most tubes are manufactures with inflatable cuff But there are also uncuffed tubes. ***Most adult ETTs have a cuff inflation system consisting of a valve, pilot balloon, inflating tube, and cuff . The valve prevents air loss after cuff inflation. The pilot balloon provides a gross indication of cuff inflation. The inflating tube connects the valve to the cuff and is incorporated into the tube’s wall. Advantages:By creating a tracheal seal, ETT cuffs permit positive-pressure ventilation ,reduce the likelihood of aspiration and access is gained to tracheobroncheal tree for suction of secretions ……Disadvantages : higher cost, potential tracheal injury by cuff pressure , ***Uncuffed tubes are often used in infants and young children(Small trachea); however, in recent years, cuffed pediatric tubes have been increasingly favored TYPES

According to the type of the cuff: There are two types High volume Low pressure cuff Low volume High pressure cuff There are two major types of cuffs: 1-high pressure (low volume) High-pressure cuffs are associated with more ischemic damage to the tracheal mucosa and are less suitable for intubations of long duration. 2- Low-pressure(High volume) cuffs may increase the likelihood of sore throat (larger mucosal contact area), aspiration, spontaneous extubation, and difficult insertion (because of the floppy cuff). Nonetheless, because of their lower incidence of mucosal damage, low-pressure cuffs are most frequently employed

SHAPE 3-Double-lumen tube 1-Reinforced tubes 2-RAE tubes with nylon or steel spiral in such cases 2-RAE tubes are curved tubes 3-Double-lumen tube to ventilate the lungs in thoracic surgery if necessary independently

LARYNGEAL MASK AIRWAY (LMA) The laryngeal mask airway (LMA) is a supraglottic airway device.The LMA provides an alternative to ventilation through a face mask or an ETT Inserted via the mouth to cover the laryngeal inlet Sealed by inflatable cuff Provides reliable airway Less irritating to the patient

LMA SIZE LMA is produced in a variety of sizes suitable for all patients, from neonates to adults, with sizes 3, 4 and 5 being the most commonly used in female and male adult.

Relative contraindications for the LMA pharyngeal pathology (eg, abscess), pharyngeal obstruction, Elective ventilation (those who cannot be mask ventilated It is often used for short procedures when endotracheal intubation is not necessary low pulmonary compliance (eg, restrictive airways disease) Difficult airway After failed intubation, the LMA can be used as a rescue because of its ease of insertion and relatively high success rate (95–99%). Lifesaving device aspiration risk (eg, pregnancy, hiatal hernia) Cardiac arrest the LMA as an acceptable alternative to intubation for airway management in the cardiac arrest patient This may be particularly useful in the prehospital setting, where emergency medical technicians typically have less experience with intubation and lower success rates

The use of the laryngeal mask overcomes some of the problems of the previous techniques: It is not affected by the shape of the patient’s face or the absence of teeth. The anaesthetist is not required to hold it in position, avoiding fatigue and allowing any other problems to be dealt with. The LMA partially protects the larynx from pharyngeal secretions (but not gastric regurgitation), and it should remain in place until the patient has regained airway reflexes. This is usually signaled by coughing and mouth opening on command Sore throat is a common side effect following LMAuse. Injuries to the lingual, hypoglossal, and recurrent laryngeal nerves have been reported. Correct device sizing, avoidance of cuff hyperinflation, adequate lubrication, and gentle movement of the jaw during placement may reduce the likelihood of such injuries

Advantages and disadvantages of the laryngeal mask airway compared with face mask ventilation or tracheal intubation Dr. Med. Khaled Radaideh May 19

Thank You