4. 1- For supporting ventilation in patient with some pathologic disease as:- : Upper airway obstruction : Respiratory failure : Loss of conciousness

5. 2- For supporting ventilation during general anesthesia  Type of surgery : Operative site near the airway : Abdominal or thoracic surgery

6. : Prone or lateral position : Long period of surgery  Patient has risk of pulmonary aspiration  Difficult mask ventilation

7. ANATOMY OF AIRWAY

8. : Congenital anomalies ---> Pierre Robin syndrome, Down’s syndrome : Infection in airway--> Retropharyngeal abscess, Epiglottitis : Tumor in oral cavity or larynx  1) Condition that associated with difficult intubation

9. : Enlarge thyroid gland trachea shift to lateral or compressed tracheal lumen  1) Condition that associated with difficult intubation (con’t)

10. : Maxillofacial,cervical or laryngeal trauma : Temperomandibular joint dysfunction : Burn scar at face and neck : Morbidly obese or pregnancy 1) Condition that associated with difficult intubation (con’t)

11. 2)Interincisor gap : normal -> more than 3 cms

12. Soft palate Uvula 3) Mallampati classification: Class 3,4 -> may be difficult intubation

13. Laryngoscopic view grade 3,4 -> risk for difficult intubation

14. 4) Thyromental distance : more than 5 cms

15. 6) Flexion and extension of neck

16. 7) Movement of temperomandibular joint (TMJ) Grin ding

18. 1) Laryngoscope : handle and blade

19. F Macintosh (curved) and Miller (straight) blade F Adult : Macintosh blade, small children : Miller blade Miller blade Macintosh blade

20. 2) Endotracheal tube

21.  1) Size of endotracheal tube : internal diameter (ID)  Male: ID 8.0 mms. Female : ID 7.5 mms  New born - 3 months : ID 3.0 mms  3-9 months : ID 3.5 mms  9-18 months : ID 4.0 mms  2- 6 yrs : ID = (Age/3) + 3.5  > 6 yrs : ID = (Age/4) + 4.5

22. 3) Endotracheal tube cuff High volume Low pressure cuff Low volume High pressure cuff  2) Material : Red rubber or PVC

23. 4) Bevel 5) Murphy’s eye

24. 6) Depth of endotracheal tube : Midtrachea or below vocal cord ~ 2 cms Adult -> Male = 23 cms,Female = 21 cms Children Oral endotracheal tube = (Age/2) + 12 (cm) Nasal endotracheal tube = (Age/2) + 15 (cm)

25. 7) Tube markings A.Z-79 B.Disposible (Do not reuse) C.Oral/ Nasal D.Radiopaque marker

26. 3.1 Stylet

27. 4) Oropharyngeal or nasopharyngeal airway Oral airway Nasal airway

28. 5) Suction catheter 6) Slip joint

29. 6) Face mask and self inflating bag 7)Magill forcep

30. 8) Syringe 9) Lubricating jelly 10) Plaster for strap endotracheal tube 4. Monitoring success of endotracheal intubation 4.1) Stethoscope 4.2) Endtidal - CO2 4.3) Pulse oximeter

31. Flexion at lower cervical spine Extension at atlanto-occipital joint

35. Vareculla

39. F Advantage 1) Comfortable for prolong intubation in postoperative period 2) Suitable for oral surgery : tonsillectomy, mandible surgery 3) For blind nasal intubation 4) Can take oral feeding 5) Resist for kinking and difficult to accidental extubation

40. 1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong intubation 3) Risk for bacteremia 4) Smaller diameter than oral route -> difficult for suction

41. 1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess

42. 1) During intubation : Trauma to lip, tongue or teeth : Hypertension and tachycardia or arrhythmia : Pulmonary aspiration : Laryngospasm : Bronchospasm

43. 1) During intubation : Laryngeal edema : Arytenoid dislocation -> hoarseness : Increased intracranial pressure : Spinal cord trauma in cervical spine injury : Esophageal intubation

44. : Obstruction from klinking, secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit 2) During remained intubation

45. : Pulmonary aspiration : Lip or nasal ulcer in case with prolong period of intubation : Sinusitis or otitis in case with prolong nasoendotracheal intubation

46. 3) During extubation F Laryngospasm F Pulmonary aspiration F Edema of upper airway

47. 4) After extubation F Sore throat F Hoarseness F Tracheal stenosis (Prolong intubation) F Laryngeal granuloma