Tracheal intubation

Elsevier

Available online 17 October 2022

Anaesthesia & Intensive Care MedicineAbstract

Tracheal intubation is the act of placing a tube into the trachea thus enabling oxygen delivery and carbon dioxide removal. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protecting against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but indirect laryngoscopy (via a videolaryngoscope) has become a common alternative. Prior to embarking upon intubation, a thorough patient history and examination must be undertaken by the laryngoscopist; equipment must be prepared and checked; a trained assistant present; and an experienced anaesthetist available in case assistance is required. Once the endotracheal tube has been placed, correct positioning must be confirmed via both clinical examination and monitoring, which must include capnography. Tracheal intubation is a procedure that should only be undertaken by trained operators and is not without risk. It is important to note that it is failure to oxygenate patients rather than failure to intubate that ultimately leads to serious morbidity and mortality. The Difficult Airway Society has produced guidelines on how to manage unanticipated difficulty in tracheal intubation; it is essential that every practitioner trained to intubate patients is familiar with these algorithms and the key principles of safe airway management.

Keywords

Airway

anaesthesia

capnography

endotracheal

extubation

intubation

laryngoscopy

oxygenation

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© 2022 Published by Elsevier Ltd.

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