endotracheal intubation

Endotracheal intubation refers to the insertion of a specially designed endotracheal tube into the patient's trachea through the mouth or nasal cavity. It is a technique for endotracheal anesthesia and rescue of patients, and is the most reliable means of keeping the upper respiratory tract unobstructed. Tracheal or endobronchial intubation is a safety measure for anesthesia. Treatment of diseases: acute respiratory failure, respiratory failure Indication Indications for endotracheal intubation: 1. During general anesthesia: the respiratory tract is difficult to ensure smoothness such as intracranial surgery, thoracotomy, general position for general position such as prone position or sitting position; for example, neck tumor compression trachea, jaw, face, neck, facial features, etc. Maize surgery, extremely obese patients; general anesthetics have significant inhibition of breathing or the application of muscle relaxants; all should be endotracheal intubation. 2. Endotracheal intubation plays an important role in the rescue of critically ill patients. Intra-tracheal intubation is required for respiratory failure requiring mechanical ventilation, cardiopulmonary resuscitation, drug poisoning, and severe neonatal asphyxia. 3, some special anesthesia, such as combined with cooling, antihypertensive and intravenous procaine combined anesthesia. Contraindications Contraindications for endotracheal intubation 1, absolute contraindications: laryngeal edema, acute laryngitis, submucosal hematoma, intubation injury can cause severe bleeding; unless first aid, contraindications for endotracheal intubation. 2, relatively contraindications: Incomplete respiratory obstruction intubation indications, but taboo rapid induction of intubation. Hemorrhagic blood disease (such as hemophilia, thrombocytopenic purpura, etc.). Intubation injury is easy to induce subglottic or tracheal submucosal hemorrhage or hematoma in the laryngeal region, secondary to acute obstruction of the respiratory tract, so it should be listed as a relative contraindication. Aortic aneurysm compression of the trachea, intubation may lead to aortic aneurysm rupture, should be listed as a relative contraindication. Anesthesiologists have not mastered the basic knowledge of intubation, and those who are inexperienced in intubation techniques or incomplete intubation equipment should be classified as relative contraindications. Preoperative preparation Preparation before intubation: Choose the right endotracheal tube. Prepare a suitable laryngoscope, intraductal guidewire, suction tube, dental pad, syringe, etc. Prepare an anesthesia mask and aeration device. Stethoscope, oxygen saturation monitor. Surgical procedure Oral clear intratracheal intubation method After exposing the glottis under direct vision with a laryngoscope, the catheter is inserted into the trachea through the mouth. 1. The patient's head is tilted back, and the lower jaw is lifted forward and upward to open the mouth, or the right thumb is facing the lower dentition, the index finger is facing the upper dentition, and the rotation is used to open the mouth. 2. Hold the laryngoscope handle on the left and put the laryngoscope lens into the mouth from the right corner. Push the tongue to the side and slowly push it forward to see the hanging sag. Lift the lens upright until the epiglottis is revealed. Pick up the epiglottis to reveal the glottis. 3. If a curved lens cannula is used, the lens is placed at the junction of the epiglottis and the base of the tongue (the epiglottis valley), and the force is lifted forward and upward to make the hyoid bone tense ligament tense, and the epiglottis is lifted close to the laryngoscope lens, that is, the glottis is revealed. If a straight lens is used for intubation, the epiglottis should be directly provoked and the glottis can be revealed. 4. Hold the middle and upper sections of the catheter with the right thumb, forefinger and middle finger, and hold the pen from the right corner into the mouth until the catheter approaches the throat and then move the end to the laryngoscope. The narrow gap between them monitors the direction of advancement of the catheter and accurately and lightweightly inserts the tip of the catheter into the glottis. When the tube is inserted into the trachea, the catheter should be inserted into the trachea after the end of the catheter is inserted into the glottis. The depth of insertion of the catheter into the trachea is 4 to 5 cm for adults, and the distance from the tip of the catheter to the incisors is about 18 to 22 cm. 5. After the intubation is completed, make sure that the catheter has entered the trachea and is fixed. The confirmation methods are: 1 When the chest is pressed, there is airflow at the mouth of the catheter. 2 During artificial respiration, the bilateral thoracic symmetry is visible, and a clear alveolar breath sound can be heard. 3 If a transparent catheter is used, the wall of the tube will be clear when inhaling, and a clear "white fog"-like change will be seen during exhalation. 4 If the patient has spontaneous breathing, the respiratory sac can be seen to contract with the breathing after receiving the anesthesia machine. 5 If it can monitor the end-expiratory ETC02, it is easier to judge. If the ETC02 graph is displayed, it can be confirmed. complication Complications of endotracheal intubation 1. Intubation operation technology is not standardized, can cause tooth damage or shedding, and mucous membrane damage in the mouth, throat and nasal cavity causes bleeding. Improper or excessive force can also cause dislocation of the mandibular joint. 2. Intratracheal intubation with shallow anesthesia can cause severe cough, throat and bronchospasm; heart rate increases and blood pressure fluctuate sharply, leading to myocardial ischemia. Severe vagal reflexes can cause arrhythmias and even cardiac arrest. Prevention methods include: appropriate deepening of anesthesia, intubation of the throat and tracheal surface anesthesia, application of narcotic analgesics or short-acting antihypertensive drugs. 3. The inner diameter of the tracheal tube is too small, which can increase the respiratory resistance. If the inner diameter of the catheter is too large, or the texture is too hard, it will easily damage the respiratory mucosa, or even cause acute laryngeal edema, or chronic granuloma. The catheter is too soft to be deformed, or the airway obstruction is caused by compression or kink. 4. If the catheter is inserted too deeply, it may be mistaken into one of the bronchial tubes, causing hypoventilation, hypoxia or postoperative atelectasis. When the catheter is inserted too shallow, it can accidentally come out due to changes in the patient's position, resulting in a serious accident. Therefore, the depth of catheter insertion should be carefully examined after intubation and when changing position, and the respiratory sounds of both lungs should be routinely auscultated.