Healthcare and Medicine Reference
In-Depth Information
CHAPTER 15
Therapeutic: Endotracheal Intubation
Randeep Mullhi
Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham, UK
• , which lies behind and around the larynx. It
extends from the level of the epiglottic tip to the C6 level where
it becomes continuous with the oesophagus. The larynx projects
into the laryngopharynx forming a deep recess (the pyriform
fossa) on each side (Figure 15.1).
The larynx lies between the pharynx and trachea, extending
from C3 to the C6 vertebra. It is composed of hyoid bone and
epiglottic, thyroid, cricoid, arytenoid, cuneiform and corniculate
cartilages. These are joined by numerous muscles and ligaments
(Figure 15.2).
The trachea is a continuation of the larynx. It is approximately
10 cm long and 2 cm wide in the adult. It is attached by the
cricotracheal ligament to the lower level of the cricoid cartilage
at the level of the C6 vertebra. It continues downwards to
bifurcate into left and right main bronchi at the level of T4
(Figure 15.3).
laryngopharynx
OVERVIEW
By the end of this chapter you should understand:
indications for tracheal intubation and associated complications
anatomy of pharynx, larynx and trachea
how to perform tracheal intubation
the diffi cult airway and strategies for management
the surgical airway
situations requiring the use of cricoid pressure.
Introduction
Tracheal intubation is considered the optimal method of securing a
patient's airway. It involves placing a cuffed tube in the trachea.
Indications
Protection from aspiration, e.g. in patients with decreased
Equipment
Laryngoscope
A laryngoscope consists of a handle and blade. A curved Macintosh
blade is most often used. The most frequently used design has a
bulb screwed on to the blade. The battery is housed in the handle.
An electrical connection is made when the blade is opened ready
for use (Figure 15.4).
Glasgow Coma Score (<8) due to head injury or anaesthesia.
Where positive pressure ventilation is required, e.g. in patients
undergoing neurosurgery following intracranial bleed.
Cardiorespiratory arrest.
Restricted access to the patient, e.g. maxofacial surgery, helicopter
transport etc.
Anatomy of pharynx, larynx and trachea
The pharynx is the common upper end of the respiratory and
gastrointestinal tracts. It is a fi bromuscular tube extending from
the base of the skull to the level of the C6 vertebra. It then continues
as the oesophagus.
The pharynx is divided into:
nasopharynx
Nasopharynx
, which lies behind the nasal cavity but above the soft
palate
oropharynx
, which lies behind the mouth and tongue and extends
from the soft palate to the tip of the epiglottis
Oropharynx
Laryngopharynx
Epiglottis
Vocal folds
Trachea
Figure 15.1 Cross-sectional view of the pharynx.
 
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