This document discusses endotracheal intubation, including indications, anatomy, equipment, techniques, and complications. Indications for intubation include supporting ventilation for respiratory diseases, anesthesia during surgery near the airway, and risk of aspiration. Airway assessments evaluate for conditions that could make intubation difficult, such as enlarged thyroid or cervical spine injuries. Equipment includes laryngoscopes, endotracheal tubes, suction catheters, and monitors to confirm proper placement. Techniques involve positioning the patient and inserting the tube through the vocal cords into the trachea. Complications can occur during or after intubation and intubation removal, such as trauma, aspiration, or laryngospasm.

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4. Indication for endotracheal
intubation
1) For supporting ventilation in patient with some pathologic disease
- Upper airway obstruction
- Respiratory failure
- Loss of consciousness
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5. 2) For supporting ventilation during general anesthesia
- Type of surgery
1.operative site near the airway
2. Abdominal or thoracic surgery
3.Prone or lateral position
4.Long period of surgery
- Patient has risk of pulmonary aspiration
- Difficult mask ventilation
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6. ANATOMY OF AIRWAY
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7. Airway Assessments
• 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
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8. Airway Assessment
Enlarge thyroid gland
Trachea shift to
lateral or compressed
tracheal lumen
1) Condition that associated with difficult intubation (con’t)
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9. Airway Assessment
: 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)
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10. Airway Assessment
2) Interincisor gap : normal -> more than 3 cms
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11. Airway Assessment
3) Mallampati classification: Class 3,4 -> may be difficult
intubation
Soft
palate
Uvula
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12. Airway Assessment
grade 3,4 -> risk for difficult intubation
Laryngoscopic view
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13. Airway Assessment
4) Thyromental distance : more than 6 cms
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14. Airway Assessment
5) Flexion and extension of neck
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15. Airway Assessment
6) Movement of temperomandibular joint
(TMJ)
Grinding
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16. Equipment
preparation
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17. 1) Laryngoscope : handle and
blade
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18. Laryngoscopic Blade
 Macintosh (curved) and Miller (straight) blade
 Adult : Macintosh blade, small children : Miller blade
Miller blade Macintosh blade
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19. 2) Endotracheal tube
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20. Endotracheal tube
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
1) Size of endotracheal tube :
internal diameter (ID)
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21. High volume
Low pressure cuff
Low volume
High pressure cuff
2) Material : Red rubber or PVC
3) Endotracheal tube cuff
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22. 4) Bevel
5) Murphy’s eye
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23. 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)
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24. 7) Tube markings
Z-79
Disposible (Do not reuse)
Oral/ Nasal
Radiopaque marker
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25. 3) Other equipments
3.1 Stylet
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26. 3.2
Oropharyngeal
or
nasopharyngea
l airway
Oral airway Nasal
airway
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27. 3.3) Suction catheter
3.4) Slip joint
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28. 3.5) Face mask and self inflating bag
3.6) Magill forcep
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29. 3.7) Syringe
3.8) Lubricating jelly
3.9) Plaster for strap endotracheal tube
4. Monitoring success of endotracheal
intubation
4.1) Stethoscope
4.2) Endtidal - CO2
4.3) Pulse oximeter
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30. Sniffing position
Flexion at lower cervical spine
Extension at atlanto-occipital
joint
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31. Sniffing
position
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32. Steps Of Oroendotracheal
Intubation
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33. Steps of oroendotracheal intubation
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34. Steps of oroendotracheal intubation
Vareculla
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35. Steps of oroendotracheal intubation
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36. Steps of oroendotracheal intubation
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37. Nasoendotracheal
intubation
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38. Nasoendotracheal
intubation
 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
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39. Disadvantage
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
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40. Contraindication
for nasoendotracheal
intubation
1) Fracture base of skull
2) Coagulopathy
3) Nasal cavity obstruction
4) Retropharyngeal abscess
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41. Complication of
endotracheal intubation
1) During intubation
: Trauma to lip, tongue or teeth
: Hypertension and tachycardia or arrhythmia
: Pulmonary aspiration
: Laryngospasm
: Bronchospasm
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42. 1) During intubation
: Laryngeal edema
: Arytenoid dislocation -> hoarseness
: Increased intracranial pressure
: Spinal cord trauma in cervical spine injury
: Esophageal intubation
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43. 2) During remained intubation
: Obstruction from klinking , secretion or
overinflation of cuff
: Accidental extubation or endobronchial intubation
: Disconnection from breathing circuit
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44. 2) During remained intubation
•: Pulmonary aspiration
•: Lib or nasal ulcer in case with prolong period of
intubation
•: Sinusitis or otitis in case with prolong nasoendotracheal
intubation
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45. 3) During extubation
 Laryngospasm
 Pulmonary aspiration
 Edema of upper airway
4) After extubation
 Sore throat
 Hoarseness
 Tracheal stenosis (Prolong intubation)
 Laryngeal granuloma
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