Tracheal Intubation Tips

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you
2. Block pain
3. Make you sleepy or forgetful
4. Make you unconscious for your surgery

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to death & brain damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:

1. Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome.
2. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
3. Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome. If you wish to discuss about any specific problem, you can consult a general surgeon.

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome. If you wish to discuss about any specific problem, you can consult a General Surgeon.

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you
2. Block pain
3. Make you sleepy or forgetful
4. Make you unconscious for your surgery

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:

1. Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
2. Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

1. Airway Obstruction
2. Inadequate inspired oxygen delivery
3. Aspiration
4. Endobronchial Intubation
5. Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

1. Pulse Oximetry
2. Capnometry
3. Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.

Implications of cough before and after surgery: it's prevention and treatment are key to judicious management

Patients with cough frequently present to clinicians working in both primary and secondary care. Acute cough, which often follows an upper respiratory tract infection, may be initially disruptive but is usually self limiting and rarely needs significant medical intervention. Chronic cough often points towards some underlying lung pathology but many a times it presents as the sole manifestation of some throat pathology as well. Even with a clear diagnosis, cough can be difficult to control and, for the patient, can be associated with impaired quality of life. Any surgery may have some implications on the course of cough for any cause, whatsoever. On the other hand, surgery, per say, may create some situations which lead to distressing cough.

Acute cough before surgery:

May occur as an exacerbation of chronic underlying lung disease eg. Asthma, copd or lung fibrosis or an acute viral illness, commonly. The chronic disease should be evaluated in terms of lung function to predict post-operative risk for prolonged ventilation. Any acute viral illness causing distressing cough may entail delaying the surgery for 6 weeks, depending on the assessment of concerned anaesthesiologist. This is due to the fact that an acute viral infection may make the person more susceptible to the ill effects of anaesthetic agents. Another issue regarding the effect of violent cough in some specific form of surgery like cataract extraction is the adverse operative outcome due to raised pressure in eyes with every bout. So, the cough needs to get controlled by applying vigorous measures, depending on the cause and extent of cough, in such special cases.

Post- operative cough:

There could be several causes occurring not very rarely in many post-operative cases. The causes may be:
I) effect of anaesthetic gases
Ii) laryngeal swelling due to placement of plastic tube in airways during any prolonged surgery
Iii) segmental lung collapse due to lack of chest wall movement
Iv) infection in lower airways due to any compromised immune status or pre-existing illness
V) partial damage of a nerve named phrenic nerve in any upper abdominal surgery, causing partial immobility to the diaphragm
Most of the conditions deserve separate attention, but common post-operative measures taken to mitigate cough, are:
a) post-operative deep breathing exercises
b) incentive spirometry
c) chest physiotherapy
d) steam inhalation, mostly for tracheal problems regarding intubation
e) inhaled bronchodilators as and when necessary
f) suitable antibiotics, as needed

Good effect of cough, post-operatively

Mainly after thoracic and upper abdominal surgeries, cough-reflex is very important. The natural defence mechanism to clear the airways, is utterly needed in these cases to prevent post-operative pneumonia. The only precaution to be taught is, the patient has to immobilise the operative site with a clinching pillow, while coughing, to prevent wound dehiscence and other complications.
To summarise, cough as a reflex to clear the airways, is welcome proposition to prevent stasis of secretions and subsequent infection. But, distressing and uncontrolled cough is a real worrisome phenomenon, needing meticulous prevention and control before and after surgery, to avoid untoward complications.

When it comes to accidents and other such traumatic incidents, a concise approach is needed to assess and manage the person’s injuries. The immediate response to an accident is known as basic life support and can be performed by anyone, but advanced trauma life support must be performed by a certified medical practitioner. The main objective of trauma life support is to address the greatest threat to life first.

Trauma life support has three stages primary survey, secondary survey and tertiary survey. A primary survey is the first part of proving trauma life support. This should be addressed in a series of steps that follows the mnemonic, ABCDE.

1. Assess the airways: If the person is able to talk, his airways are clear. Hence call out to the person and try to get a verbal response. If the patient is unconscious, make him lie down on the floor with the chin tilted back. Open the mouth and check for any obstructions. Fluids such as blood or vomit that is obstructing the airways may be suctioned out. In case the airway is still obstructed, an endotracheal tube may be inserted.
2. Breathing and ventilation: Check for chest movement that may indicate breathing. If present, tracheal deviation and subcutaneous emphysema should be identified. An inspection of the chest can help identify penetrating injuries, bruising, tracheal deviations and a flail chest segment.
3. Circulation: Look out for hypovolemic shock that may be caused by excessive bleeding. This bleeding can be controlled by applying direct pressure on the wound. Establish two intravenous lines and administer crystalloid solution to the patient. If the person still does not respond, administer type specific blood or O negative blood to the person.
4. Disability assessment: A basic neurological assessment can be made by alerting the person, verbal stimuli and its response or unresponsiveness. Towards the end of the primary survey, the Glasgow coma scale can be used to determine the patient’s level of consciousness.
5. Exposure control: While the patient’s clothes will need to be completely removed, protect him from hypothermia by covering him with warm blankets. Warm intravenous fluids before administering them and maintain a warm environment.

Once the patient’s vital signs are turning normal, the medical practitioner can start the secondary survey. This involves a head to toe medical examination and understanding of family medical history. X-rays of the injury sites may also be taken. If at any point, the person’s condition begins to deteriorate, a primary survey should be repeated. As soon as possible, the patient must be shifted off the hard spine board and placed on a firm mattress. This is followed by a tertiary survey, which helps identify injuries that may have been missed earlier and other related problems.

When it comes to accidents and other such traumatic incidents, a concise approach is needed to assess and manage the person’s injuries. The immediate response to an accident is known as basic life support and can be performed by anyone, but advanced trauma life support must be performed by a certified medical practitioner. The main objective of trauma life support is to address the greatest threat to life first.

Trauma life support has three stages primary survey, secondary survey and tertiary survey. A primary survey is the first part of proving trauma life support. This should be addressed in a series of steps that follows the mnemonic, ABCDE.

1. Assess the airways: If the person is able to talk, his airways are clear. Hence call out to the person and try to get a verbal response. If the patient is unconscious, make him lie down on the floor with the chin tilted back. Open the mouth and check for any obstructions. Fluids such as blood or vomit that is obstructing the airways may be suctioned out. In case the airway is still obstructed, an endotracheal tube may be inserted.
2. Breathing and ventilation: Check for chest movement that may indicate breathing. If present, tracheal deviation and subcutaneous emphysema should be identified. An inspection of the chest can help identify penetrating injuries, bruising, tracheal deviations and a flail chest segment.
3. Circulation: Look out for hypovolemic shock that may be caused by excessive bleeding. This bleeding can be controlled by applying direct pressure on the wound. Establish two intravenous lines and administer crystalloid solution to the patient. If the person still does not respond, administer type specific blood or O negative blood to the person.
4. Disability assessment: A basic neurological assessment can be made by alerting the person, verbal stimuli and its response or unresponsiveness. Towards the end of the primary survey, the Glasgow coma scale can be used to determine the patient’s level of consciousness.
5. Exposure control: While the patient’s clothes will need to be completely removed, protect him from hypothermia by covering him with warm blankets. Warm intravenous fluids before administering them and maintain a warm environment.

Once the patient’s vital signs are turning normal, the medical practitioner can start the secondary survey. This involves a head to toe medical examination and understanding of family medical history. X-rays of the injury sites may also be taken. If at any point, the person’s condition begins to deteriorate, a primary survey should be repeated. As soon as possible, the patient must be shifted off the hard spine board and placed on a firm mattress. This is followed by a tertiary survey, which helps identify injuries that may have been missed earlier and other related problems. If you wish to discuss about any specific problem, you can consult a general physician.

Mechanical ventilation is the artificial method of assisting a person to breathe with the help of a device called ventilator. It is employed when a person’s spontaneous breathing who has been affected and cannot breathe on his/her own.

When is Mechanical Ventilation indicated?

Several injuries or other medical conditions could call for assisted breathing-

• Apnea (inhalation muscles become non-functional) that leads to intoxication and respiratory arrest
• Lung injury or trauma that leads to an inadequate exchange of gases between the lungs
• Acute asthma that requires intubation
• Chronic obstructive pulmonary disease
• Obesity hypoventilation syndrome
• Respiratory acidosis (excessive carbon dioxide in the blood)
• Respiratory distress like tachypnea that leads to rapid breathing
• Hypoxemia (too little oxygen in the blood)
• Muscular dystrophy (weakening of skeletal muscles)
• Amyotrophic lateral sclerosis (neurons controlling the voluntary muscles die)

Duration of artificial respiration

1. It is used for the entire duration of a surgery.
2. Long-term ventilation is necessary for people suffering from chronic illnesses who have been hospitalized. In such cases, special measures are taken to stabilize the trachea.
3. It can be used by ailing persons at home as well.

How is mechanical ventilation performed?

1. A tube is inserted into the trachea. This process is called intubation. The tube goes in through the mouth or nose (endotracheal tube). The tube is kept in place with a metal strap that goes around the head. The other end of the tube is attached to the ventilator. The ventilator pumps oxygen and other gases into the lungs. It can be a painful process, and before surgeries, it is performed under anaesthesia.

2. The tube can be inserted through a surgical hole in the throat. This process is called tracheotomy.

When the ventilator applies pressure to blow air into the lungs, it is called positive pressure. the exhalation can be done by the person himself/herself or if spontaneous respiration is compromised, the ventilator will help pump out the carbon dioxide.

Both types of tubes affect a person’s ability to speak because they pass through the vocal chords. Tracheotomy is performed on people who will require ventilation for long stretches of time because endotracheal tubes are uncomfortable and sometimes painful.

Risks associated with artificial ventilation:

1. The gravest risk is that of pneumonia. A person who is undergoing ventilation is already physically weak. And that makes the person susceptible to a wide range of diseases. The tube that is inserted into the trachea allows the entry of different types of bacteria. The result is Ventilation Associated Pneumonia (VAP). Because the tube is always present in the trachea, a person cannot cough. Coughing flushes out many bacteria. VAP is curable with antibiotics.

2. Endotracheal tubes may also lead to a sinus infection

3. Pneumothorax is yet another risk linked with artificial ventilation. Air leaks from the lungs and this causes pain and in extreme cases may even lead to the collapse of the lungs.

4. Because air is pushed into the lungs with pressure, it might cause lung damage.

5. Too much oxygen is also harmful to the lungs.

Taking a person off ventilation

This process is called weaning. The ventilator is turned off but still attached to the person. The person is allowed to breathe on his/her own. If there are difficulties, the ventilator is turned back on. It is like a trial run. Gradually the individual develops the ability to breathe on his/her own.

Mechanical ventilation is a painful and often risky method. But when a person is unable to breathe, it is the only way to save his/her life.