INTUBASI
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Transcript of INTUBASI
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1) For supporting ventilation in pa tient with some pathologic disea
se : U pper airway obstruction
: Respi rat ory failure : L oss of con
ciousness
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For supporting ventilation during general anesthesia
Type of surgery
: Operative site near the airway
: Abdominal or tho racic surgery
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: Prone or lateral position
: Long period of surgery
Patient has risk of p ulmonary aspiration Difficult mask ventilation
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ANATOMY OF AIRWAY
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--- : Congenital anomalies > Pier re Robin syndrome , Down’s sy
ndrome -- : Infection in airway > Retroph
aryngeal abscess, Epiglottitis : Tumor in oral cavity or larynx
1 ) Condition that associate d with difficult intubation
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- 2) Interincisor gap : normal > more th 3an cms
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3) Mallampati classification: Clas - 34s , > may be difficult intubat
iii Soft pa
lateUvula
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- 34grade , > risk for difiiiiii iiiiiiiiii
Laryngoscopic view
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4) : 6Thyromental distance more than cii
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5) Flexion and extension of neck
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iiiiiiiiiiiiiiiii iiiii iiiii 6) ()
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1) Laryngoscope : handle and blade
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Macintosh (curved) and Miller (straight ) blade
Adult : Macintosh blade, small children : Miller blade
Miller blade Macintosh blade16
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2 ) Endotracheal tube
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80 7Male: ID . mms . Female : ID . 5 mms
- ii i ii i i3 : 3 . 0i
- 3 9 : 3 .5months ID mmi
- 918 40months : ID . mii
- ii i 2 6 : = (/3) +3 .5
ii i > 6 : = (4Age/ ) 45+ .
1) Size of endotracheal tube : internal diameter (ID)
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3) Endotracheal tube cuff
High volume Low pressure cuff
Low volume High pressure cuff
2) Material : Red rubber or PVC
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4) Bevel iii5) ’
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6 ) Depth of endotracheal tube : Mid 2trachea or below vocal cord ~
cms - ii i iiii iii > = 2 3 ,
21= cms iiiiiiii
iiii iiiiiiiiiiii iiii = ( 2Age/
i 12+ (cm) iiiiiiiiiiii iiii i = (2Age/ )
15+ (cm)
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7 ) Tube markings
-79Ziiiiiiiiii iii iii iiiiii Oral/Nasal Radi opaque marker
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31. Stylii
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3.2 Oropharyngeal or nasopharyngeal airway
Oral airway Nasal airway
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33. ) Suction catheter 34. ) Slip joint
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3.5)Face mask andsel f i nfl at i ngbag
36. ) Magill forcep
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37. ) Syringe 38. ) Lubricating jelly 39. ) Plaster for strap endot
iiiiiii iiii 4. Monitoring success of
iiiiiiiiiiii iiiiiiiiii
4.1) Stethoscope - 42. ) Endtidal CO
2
43. ) Pulse oximeter27
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Vareculla
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Advantage 1) Comfortable for prolong intu
iiiiii ii iiiiiiiiiiiii iiiiii 2 ) :Suitable for oral surgery to
nsillectomy , mandible surgery 3 ) For blind nasal intubation 4 ) Can take oral feeding 5) Resist for kinking and difficul
i ii iiiiiiiiii iiiiiiiiii36
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1) Trauma to nasal mucosa 2) Risk for sinusitis in prolon
i iiiiiiiiii 3) Risk for bacteremia 4) Smaller diameter than or
iiiii -i iiiiiiiii iii ii>iiiii
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1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess
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i iiiii iiiiiiiiii1 ) :Traumato l i p,tongue or teeth : Hypertension and tachyc
ardia or arrhythmia : Pulmonary aspiration : Laryngospasm : Bronchospasm
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1) During intubation iiiiiiiii iiii i:
: i iiiiiiiiiii -i iiii>iiiiii
: Increased intracranial pressiii
:Spi nal cordtrauma i ncervi cai iiiii iiiiii
:Esophageal i ntubati on
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: Obstruction from klinking , secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit
2) During remained intubation
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2) During remained intubation
: Pulmonary aspiration : Lib or nasal ulcer in case
with prolong period of intubation
: Sinusitis or otitis in case with prolong nasoendotrac heal intubation
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3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway
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4) After extubation
Sore throat Hoarseness Tracheal
stenosis (Prolong intubation)
Laryngeal granuloma
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