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.

What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.

Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own. 

Why ICU pateint put on ECMO?

Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.

ICU patients’ lungs fail for a number of reasons including pneumonia, lung cancer, pulmonary edema, pulmonary embolism and COPD.

 When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
 However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.

This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.

How long can someone stay on ecmo?

That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.

What is the difference between ecmo and a ventilator (breathing machine)?

Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.