Technique and complications of laryngoscopy

TECHNIQUE AND COMPLICATIONS OF LARNGOSCOPY AND INTUBATION DR.KISHWAR KUMAR GOKLANI :

TECHNIQUE AND COMPLICATIONS OF LARNGOSCOPY AND INTUBATION DR.KISHWAR KUMAR GOKLANI

Slide 2:

The first laryngoscope was invented in 1854 A laryngoscope (larynx + scope) is a medical instrument. That is used to obtain a view of the vocal folds and the glottis, which is the space between the cords is called laryngoscopy . Definitions of Laryngoscopy

Slide 3:

TYPES OF LARYNGOSCOPY There are two types of laryngoscopy ; 1- Direct laryngoscopy 2- Indirect laryngoscopy

Slide 4:

Why We Do Laryngoscopy ? To facilitate tracheal intubation for mechanical ventilation during general anesthesia or cardiopulmonary resuscitation F or procedures on the larynx or other parts of the upper tracheobronchial tree . Suction Foreign body Vocal cord function

Slide 5:

DIFFERENT TYPES OF LARYNGOSCOPES

Slide 8:

Parts of Laryngoscope

Slide 10:

PRE REQUESITE PRE OPERATION : History Evaluation of the airway Anaesthesia trolley

Slide 11:

Evaluation of the airway Anatomic characteristics associated with difficult airway management ● Short muscular neck ● Receding mandible ● Protruding maxillary incisors/ Buck teeth ● Long high-arched palate ● Inability to visualize uvula ● Limited temporomandibular joint mobility ● Limited cervical spine mobility

Slide 12:

Evaluation of the airway Assessment of airway associated with difficult airway Management: ● Mallampati’s classification ● Atlanto -occipital joint extension ● Thyromental distance ● Sternomental distance Class III < 35 < 6 cm or 3 FB < 12 cm

Slide 13:

ASSESSMENT OF AIRWAY Mallampati classification and thyromental distance Patil’s Test

Slide 16:

Preparation for Rigid Laryngoscopy (trolley) Suction ETT of different sizes Airway Laryngoscope/one more of same size/ pair of batteries 10cc syringe for inflation of cuff Magill forcep Surgical tape/bandage for tying of tube Stylet / Bougie Local spray/local gel (lubricant) Throat pack Emergency medicines Anesthetic machine / Breathing system /vaporizers Monitoring : Pulse Oximeter, Capnograph, ECG, NIBP

Slide 17:

Techniques for intubation ROUTINE RAPID-SEQUENCE UNPREPARED (CRUSH CALL) THREE WAYS :

Slide 18:

Techniques for routine intubation ● Preoxygenation ● Administration of induction agent ● Administration of non depolarizing neuromuscular blocking agent ● Adequate mask ventilation ● Intubation ● Confirm tube in trachea

Slide 19:

Technique for “rapid-sequence ” induction and intubation ● Preoxygenation 3 min ● Administration of induction and depolarizing NM blocking agents ● Cricoid pressure ( Sellick maneuver ) ● “No” mask ventilation ● Release cricoid pressure after confirmation of tube in trachea

Intubation Technique:

Intubation Technique Position bed height to bring the patient's head to a mid-abdominal height Ventilate with 100 percent oxygen for approximately 3 min Flex the cervical spine and extend the head at the atlanto -occipital joint by putting a pillow of 10cm thickness under head of patient Long axis of the oral cavity, pharynx, and trachea lie almost in a straight line

Intubation Technique:

Intubation Technique Introduce the blade into the right side of the patient's mouth Move the blade posteriorly and toward the midline, sweeping the tongue to the left and keeping it away from the visual path with the flange of the blade Ensure the lower lip is not being pinched by the lower incisors and laryngoscope blade Advance the laryngoscope until the epiglottis is in view

Intubation Technique:

Intubation Technique lift the laryngoscope upward and forward, than tracheal opening will be in front us. Insert the endotracheal tube from the right. Maneuver the endotracheal tube into the larynx, leave after tube cuff crossed the vocal cord

Intubation Technique:

Intubation Technique Inflate the cuff and apply positive pressure ventilation while the assistant auscultates Secure the endotracheal tube in position

Slide 24:

patient's head to a mid-abdominal height & Ventilate with 100 percent oxygen

Slide 26:

Flex the cervical spine and extend the head at the atlanto -occipital joint

Slide 27:

Introduce the blade into the right side of the patient's mouth

Slide 28:

Move the blade posteriorly and toward the midline, sweeping the tongue to the left

Slide 29:

Advance the laryngoscope until the epiglottis is in view. lift the laryngoscope upward and forward , tracheal opening will be in front you

Slide 30:

Insert the endotracheal tube & Secure the ETT in position.

Slide 31:

Auscultate at five places

Slide 32:

Sign of Tracheal Intubation ● Chest expansion and decompression (Chest rise & fall) • Auscultate at five places • No gastric distention ● No breath sound over stomach

Slide 33:

Nasal Intubation Dental operations ENT operations Long term intubation

Slide 34:

Awake fibre -optic intubation Indication: Anticipated difficult intubation , laryngoscopy or mask ventilation Cervical spine instability or cord injury To avoid haemodynamic instability during intubation

Slide 35:

Complications During Laryngoscopy & Intubation While tube in place Following Extubation

Slide 36:

● Trauma – Tooth damage – Lip, tongue, mucosal laceration – Dislocated mandible – Retropharyngeal dissection – Cervical spine During Laryngoscopy Complications:

Slide 37:

Complications: During Laryngoscopy ● Physiologic reflexes – HT, Arrthymia – Intracranial pressure raised – Intraocular pressure raised – Bronchospasm

Slide 38:

During Intubation ● Malposition – Esophageal Intubation – Bronchial Intubation ● Tube malfunction – Cuff perforatio n Complications:

Slide 39:

Complications: While tube in place ● Malpositioning – Unintentional Extubation – Endobronchial Intubation – Laryngeal cuff malposition ● Airway trauma – Mucosal inflammation – Excoriation of nose

Slide 40:

● Tube malfunction – Ignition – Obstruction / Kinking ● Aspiration While tube in place Complications:

Slide 41:

Complications: Following Extubation ● Airway trauma – Edema, Stenosis – Hoarseness / Sorethroat – Laryngeal malfunction ● Physiologic reflexes ● Laryngospasm ● Aspiration

Slide 42:

Awake fibre -optic intubation’s comlications Poor compliance coughing Bleeding in airway Excessive secretions Laryngospasm Vomiting Aspiration Airways obstruction

Slide 43:

THANK YOU VERY MUCH FOR YOUR ATTENTION GOOD LUCK