Airway Management and Intubation

1. Airway Management
and Intubation
PREPARED BY: SYED M UMAIR

2. Objectives of lecture :
Upon completion of this lecture, the student will be able to:
◦ Describe the anatomy of the airway
◦ List the instruments used in intubation
◦ Describe the different types of intubation
◦ Understand the complications of intubation
◦ Know the drugs used during intubation and their dosages
◦ Confirm the placement of an endotracheal tube (ETT)

3. Anatomy of the Airway
The airway is made up of the following structures:
Nose and mouth
Pharynx
Larynx
Trachea
Bronchi

4. Anatomy of the Airway

5. Why Is Airway Management Important?
The airway is essential for breathing. When the airway is obstructed, it can lead to respiratory
failure.
Airway management is the process of maintaining or restoring an open airway
Airway management is important because it ensures that the patient can breathe.
There are many situations in which airway management may be necessary, such as:
a) During surgery
b) In an emergency situation
c) When a patient is unconscious
d) When a patient has a blocked airway

6. Different Methods of Airway
Management
There are a variety of methods of airway management, including:
1. Basic airway adjuncts
2. Advanced airway adjuncts
3. Surgical airway

7. Basic airway adjuncts
These are simple devices that can be used to maintain an open airway,
such as the oropharyngeal airway (OPA) and the nasopharyngeal airway
(NPA).

8. Basic airway adjuncts

9. Advanced airway adjuncts
These are more complex devices that can be used to secure an airway,
such as the endotracheal tube (ETT) and the laryngeal mask airway
(LMA)

10. ETT and LMA insertion
LMA INSERTION

11. Surgical Airway
This is a procedure that is performed to create a permanent airway, such
as a tracheostomy.
Tracheostomy
tube placement

12. Types of Intubation
There are two main types of intubation:
a) Oro-tracheal intubation: This is the most common type of
intubation. The endotracheal tube is inserted through the mouth
and into the trachea.
b) Naso-tracheal intubation: This is less common than orotracheal
intubation. The endotracheal tube is inserted through the nose and
into the trachea

13. Nasotracheal intubation
Nasotracheal
intubation

14. Instruments used in intubation
1. Endotracheal tube
2. Stylet
3. Laryngoscope
4. Magill forceps
5. Suction catheter
6. Oxygen mask
7. Ambu bag

16. Drugs used during intubation
 Lidocaine: This is a local anesthetic that is used to numb the airway.
 Succinylcholine: This is a muscle relaxant that is used to relax the muscles of the airway.
 Ketamine : induction agent used to facilitate intubation
 Propofol : an induction agent for general anesthesia
 Fentanyl: This is a pain medication that is used to sedate the patient
 Midazolam : a sedative agent used to facilitate intubation

17. Step-by-step approach for intubation
of a patient
Preparation
 Gather the necessary equipment, including an endotracheal tube (ETT) of the
appropriate size, a stylet, a laryngoscope, a suction catheter, an oxygen mask, and
a stethoscope.
 Preoxygenate the patient with 100% oxygen for 3-5 minutes.
 Sedate and paralyze the patient with medications.
 Position the patient supine with the neck slightly extended.

18. Step-by-step approach for intubation
of a patient
Laryngoscopy
 Insert the laryngoscope into the right side of the mouth and advance
it until the vocal cords are visualized.
 Lift the laryngoscope blade to expose the vocal cords.
 Insert the stylet into the ETT and curve it to conform to the shape of
the vocal cords.

19. Step-by-step approach for intubation
of a patient
Insertion of the endotracheal tube
◦ Hold the ETT in your right hand and insert it through the vocal
cords and into the trachea.
◦ Advance the tube until the cuff is past the vocal cords and the stylet
is visible in the mouth.
◦ Remove the stylet and inflate the cuff with the appropriate amount
of air.

20. Step-by-step approach for intubation
of a patient
Confirmation of tube placement
◦ Auscultate the breath sounds over the right and left lung fields to
confirm that the tube is in the trachea.
◦ Palpate the chest to confirm that the tube is in the trachea.
◦ Use capnography to confirm that the tube is in the trachea.
◦ Obtain a chest X-ray to confirm the tube placement.

21. Step-by-step approach for intubation
of a patient
Secure the endotracheal tube
 Tape the ETT in place to prevent it from dislodging.
 Connect the ETT to a ventilator to provide mechanical ventilation.
Documentation
Document the procedure in the patient's medical record, including the time of intubation, the
size of the ETT, the depth of insertion, and the confirmation of tube placement.

22. Complications during intubation
The following are some of the complications that can occur during intubation:
 Laryngospasm: This is a spasm of the vocal cords that can block the airway.
 Esophageal intubation: This is when the endotracheal tube is inserted into the esophagus instead of
the trachea.
 Dental injury: This can occur if the endotracheal tube is not inserted carefully.
 Hypoxia: This is a decrease in the level of oxygen in the blood.

23. Confirmation of ETT Placement
 Auscultation of the breath sounds
 B/L rise of chest
 Capnography
 Chest X-ray

24. Auscultation of the breath sounds

25. Capnography

26. Chest X-ray

27. Thanks