Endotracheal Intubation: Indications, Procedure, and Complications

Indications For Endotracheal Intubation

Write a brief answer on endotracheal intubation.

Answer. Endotracheal intubation is the most basic skill which is acquired by an anesthesiologist.

Endotracheal intubation consists of introduction of a tube inside trachea for maintaining the patency and protecting the airway as well as to ensure proper oxygenation and ventilation.

Endotrachealintubationisthedefiitivewayofmaintaining the airway in patients who need muscle paralysis as well as intermittent positive pressure ventilation.

Whenever general anesthesia is given and needs to be maintained for long periods, endotracheal intubation is done.

Endotracheal intubation Indications

• For inducing general anesthesia for long time, i.e more than l to 2 hours.
• To maintain patency of the airway in unconscious patients.
• For protecting lungs from aspiration of regurgitated gastric contents.
• For ensuring proper delivery of adequate tidal volumes to the lungs.
• For clearing excessive as well as retained secretions from the lungs.

Endotracheal intubation Contraindications

• In cases where upper airway integrity is lost, i.e.
  • In extensive maxillofacial injury with bilateral fractures of mandible and maxillae.
  • Injuries to the neck along with laryngeal rupture
  • Large tumors of upper airway.

In above conditions, endotracheal intubation may be extremely diffilt and even dangerous. In above situations,tracheostomy may be a bettr choice.

Endotracheal intubation Technique

• A pillow of 7 to 10 cm should be positioned under patient’s head which enables mild flxion at the cervical spine.
• Head is then extended at the atlanto-occipital joint. This is known as intubating position or “sniffi position”.

Endotracheal intubation Procedure

• Endotracheal intubation can be done in multiple ways,i.e. can be done either orally or nasally; can be done either under direct vision or indirectly by fieroptic scope.
  It can be done blindly when visualization of the glotts by direct means is not possible and fireoptic scope is not available.
  In such cases, if the regular antegrade technique, i.e. mouth or nose to larynx or a retrograde intubation, i.e. larynx to mouth can be tried.
• In the retrograde technique, pass a guide wire from the cricothyroid membrane upward inside the mouth or nose and an endotracheal tube is guided over it into the larynx.
• Procedure of endotracheal intubation is done with the patient anesthetized but can also be carried out with the patient awake after administering local anesthesia to upper airway when a diffilt intubation is anticipated.
• Many of the airway adjuncts are available for use when a diffilt airway is encountered, especially when it is unanticipated.
  These include oropharyngeal airway, nasopharyngeal airway, laryngeal mask airway and Combitube®.

Endotracheal intubation Complications

Following are the complications of endotracheal intubation:

Endotracheal intubation Immediate

• Trauma to the teeth, lips, tongue, pharynx or larynx.
• Hemodynamic changes such as tachycardia, hypertension,myocardial ischemia.
• Misplaced tube, i.e. accidental extubation and esophageal intubation

Endotracheal intubation Delayed

Laryngeal granuloma, laryngeal or subglottic stenosis