Intubation Tips and Tricks

ABCs of Anaesthesia
4 Oct 202010:12
EducationalLearning
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TLDRThis informative video script covers the essentials of laryngoscopy technique and intubation, highlighting the importance of a well-lit view and the appropriate laryngoscope blade size. The speaker shares personal preferences for a size 4 Macintosh blade for most adults and offers practical tips for blade insertion, tongue displacement, and optimizing view of the trachea. The script also discusses various blade types, including video laryngoscopes, and outlines strategies for difficult intubations, emphasizing the importance of assistance, proper patient paralysis, and following the DAS guidelines. The speaker concludes with advice on tube placement and alternative techniques for challenging situations.

Takeaways
  • 🔦 The importance of a bright light source for laryngoscopy and intubation, as it greatly affects the success of the procedure.
  • 🏥 Choosing the right laryngoscope blade size, with size 3 and 4 being common for adults, and a size 4 blade being preferred for its length and leverage.
  • 💡 Tilting the head back on the atlanto-occipital joint before laryngoscopy to improve access to the trachea.
  • 📍 Inserting the laryngoscope slightly to the side to avoid obstructions and facilitate the passage of the blade.
  • 🔄 Performing a sliding motion to the left to displace the tongue and reach the oropharynx, optimizing the view of the larynx.
  • 🤔 The use of different laryngoscope blades such as the straight Miller, McCoy, and hyper-angulated blades like the D-blade for varying situations.
  • 🚑 Adhering to the DAS (Difficult Airway Society) guidelines when encountering a difficult intubation to ensure proper management.
  • 🤝 Seeking assistance, especially for junior practitioners, to improve safety and outcomes during intubation.
  • 💉 Considering the level of paralysis, ensuring the patient is adequately paralyzed for easier intubation and ventilation.
  • 🌟 Utilizing the 'BURP' (Backward, Upward, Rightward, and Posterior) maneuver to enhance the view of the larynx during difficult intubations.
  • 🌀 Rotating the endotracheal tube 90 degrees laterally before insertion to maintain a clear view as the tube passes through the vocal cords.
Q & A

  • What is the primary focus of the video?

    -The primary focus of the video is to teach the laryngoscopy technique and intubation process, emphasizing the use of a Macintosh blade and various strategies for achieving a good laryngoscopy view.

  • What type of laryngoscopy blade does the speaker prefer and why?

    -The speaker prefers a size 4 Macintosh blade because it provides the necessary length to get down into the velar region, which is crucial for obtaining the best view during intubation.

  • What are the advantages and disadvantages of using a size 3 blade compared to a size 4 blade?

    -A size 3 blade is advantageous for smaller adults and females, but it may not reach the molecular region as effectively as a size 4 blade. The size 4 blade is harder to lift when pressure is applied due to its larger lever, but it provides a better view for most intubations.

  • What are some alternative blade types mentioned for use with video laryngoscopes?

    -The speaker mentions the straight Miller blade, the McCoy blade, and hyper-angulated blades like the D-blade as alternatives for use with video laryngoscopes.

  • How does the speaker recommend positioning the head for intubation?

    -The speaker recommends tilting the head back on the atlanto-occipital joint to open the mouth slightly and provide a better aperture for viewing the trachea.

  • What is the significance of the 'burp' maneuver during intubation?

    -The 'burp' maneuver involves moving the larynx backward and upward, which can significantly improve the view of the larynx, even with a less than optimal initial view.

  • What is the order of assistance recommended by the speaker when facing difficulties in obtaining a good laryngoscopy view?

    -The speaker recommends asking for assistance (APB - Assistance, Paralysis, Bougie, Blade), starting with additional help from a colleague, ensuring the patient is adequately paralyzed, requesting a bougie (a stylet for the endotracheal tube), and finally considering a different laryngoscope blade.

  • How does the speaker suggest holding the endotracheal tube for better visibility during intubation?

    -The speaker suggests rotating the tube laterally (90 degrees clockwise) so that it is horizontal, which allows for a clear view of the larynx, the chords, and the tube passing through.

  • What are some tips for dealing with an anterior larynx that makes intubation challenging?

    -The speaker suggests pre-bending the tube or bending it on the pillow to allow it to pass through the cords more easily as it recovers its shape.

  • How does the speaker ensure they have a good trajectory to the trachea when using a video laryngoscope?

    -The speaker places their right hand on the patient's head to angle it back, which opens the mouth and provides a better trajectory to the trachea for intubation.

  • What is the importance of having additional help during intubation as emphasized by the speaker?

    -Having additional help, such as a nurse or technician, is crucial for managing difficult airway situations, ensuring patient safety, and providing extra hands and expertise, especially when the person performing intubation is less experienced.

Outlines
00:00
🌟 Laryngoscopy and Intubation Techniques

This paragraph introduces the fundamentals of laryngoscopy and intubation, highlighting the importance of a well-lit laryngoscopy blade, commonly a size 3 or 4 Macintosh blade, for successful intubation. The speaker, Lahiru, emphasizes the need for a bright light to clearly visualize the trachea. The paragraph discusses the choice between size 3 and 4 blades, with a preference for the latter due to its length allowing better access to the veloipharynx, the critical area for optimal viewing. Lahiru also shares personal techniques for inserting the laryngoscope and manipulating the tongue to achieve the best view of the trachea, as well as tips for dealing with difficult intubations, such as following the DAS difficult airway guidelines.

05:03
🛠️ Strategies for Challenging Intubations

The second paragraph delves into strategies for managing intubations when a clear view is not easily obtained. Lahiru outlines the 'APB' approach—asking for assistance, confirming adequate paralysis, and using a bougie or stylet. The 'BURP' maneuver is introduced as a technique to enhance the view after initial laryngoscopy. The paragraph also discusses the use of different laryngoscope blades, such as the Miller or McCoy, and the availability of video laryngoscopes with hyper-angulated blades like the D-blade. Lahiru provides practical tips for tube placement, such as rotating the tube laterally for better visibility, and offers solutions for situations where the larynx is anteriorly positioned. The paragraph concludes with advice on improving the laryngoscopy view by lifting the head and adjusting the blade's position, as well as the importance of teamwork and following protocols for challenging airways.

Mindmap
Keywords
💡Laryngoscopy
Laryngoscopy is a medical procedure that involves the examination of the larynx, which is the voice box, using a specialized instrument called a laryngoscope. In the context of this video, laryngoscopy is crucial for the intubation process, where a tube is inserted into the trachea to maintain an open airway. The script emphasizes the importance of a good laryngoscope and technique for achieving a clear view of the trachea during intubation.
💡Intubation
Intubation refers to the process of inserting a tube, known as an endotracheal tube, into the trachea to ensure an open airway for the patient, often during general anesthesia or in emergency situations. The video script discusses the significance of choosing the correct blade size and technique for intubation, as well as the potential challenges and strategies to optimize the procedure's success.
💡Macintosh Blade
The Macintosh blade is a type of laryngoscope blade that is widely used in intubation procedures. It is designed with a curved shape to lift the epiglottis and provide a clear view of the larynx. In the video, the speaker mentions using a size four Macintosh blade for most intubations due to its length and ability to offer a better view of the trachea.
💡Blade Sizes
Blade sizes refer to the different dimensions of laryngoscope blades used during laryngoscopy and intubation. The script mentions size four and size three as common options for adults, with the choice depending on the patient's anatomy and the clinician's preference. The correct blade size is essential for achieving a good view of the trachea and successful intubation.
💡Trachea
The trachea, also known as the windpipe, is the tube that connects the larynx to the bronchi, allowing air to pass into the lungs. In the context of the video, locating the trachea is a critical step during laryngoscopy and intubation, as the endotracheal tube must be inserted through it to ensure proper ventilation.
💡Difficult Intubation
Difficult intubation refers to situations where the process of inserting an endotracheal tube into the trachea is challenging due to various factors such as patient anatomy or other complications. The video script provides strategies to manage difficult intubation, including the use of different laryngoscope blades and techniques to improve the view of the trachea.
💡Anaesthesia
Anaesthesia is a state of controlled, temporary loss of sensation or consciousness that is induced for medical purposes, such as surgery or procedures like intubation. In the video, the speaker mentions that after the patient is anaesthetized and paralyzed, they proceed with intubation, highlighting the importance of anaesthesia in facilitating the procedure.
💡Head Tilt
Head tilt is a positioning technique used during laryngoscopy and intubation to improve the view of the trachea. By tilting the patient's head back, the atlanta-occipital joint is engaged, which helps open the mouth and provides a better angle for inserting the laryngoscope. The video script describes this as an essential step in the intubation process.
💡Lever
In the context of the video, a lever refers to the mechanical advantage gained by the shape and position of the laryngoscope blade. The size four blade has a larger lever, which makes it more challenging to lift during intubation. Understanding the leverage provided by different blade sizes is important for effectively using the laryngoscope and achieving a good view of the trachea.
💡Video Laryngoscopes
Video laryngoscopes are advanced tools that use a camera and display to provide a clear view of the airway during laryngoscopy and intubation. These devices often feature hyper-angulated blades, which allow for a better view of the trachea in difficult intubation scenarios. The video script briefly mentions different types of blades, including those used with video laryngoscopes.
💡Difficult Airway Society Guidelines
The Difficult Airway Society Guidelines are a set of recommendations for managing challenging intubation scenarios. These guidelines provide a structured approach to ensure patient safety and effective airway management. In the video, the speaker advises following these guidelines when faced with difficult intubation, emphasizing the importance of proper training and preparedness.
💡Bougie
A bougie, short for bougainvillea, is a type of intubation aid that is a flexible stylet used to guide the endotracheal tube into the trachea. It can be particularly helpful in situations where direct visualization of the trachea is not possible. The video script mentions asking for a bougie as part of the strategy to manage difficult intubation.
Highlights

Introduction to laryngoscopy and intubation techniques, emphasizing their importance in anesthesia practice.

Discussion on the common use of the Macintosh blade, particularly size 3 and 4, for adult intubation.

The necessity of a bright light source for successful laryngoscopy and intubation.

The preference for a size 4 blade for its length and ability to provide a better view of the larynx.

The advantage of the size 3 blade in terms of ease of lifting during intubation.

Explanation of different laryngoscope blades, including straight Miller, McCoy, and hyper-angulated D-blade.

The initial step of tilting the patient's head back to improve access to the trachea.

The technique of inserting the laryngoscope slightly to the side to avoid obstruction.

The method of sliding the tongue from right to left and performing a tilting motion for optimal positioning.

The importance of performing a lifting motion towards the corner of the room for a better view of the larynx.

The strategy of lifting the head for improved view and the role of an assistant in maintaining this position.

The approach when a clear view is not achievable, following the DAS guidelines and the sequence of APB (Assistance, Paralysis, Bougie, Blade).

The use of the 'burp' maneuver to enhance the view of the larynx.

The request for a bougie to assist in intubation even with a suboptimal view.

The consideration of using a different blade when the initial view is unsatisfactory.

The tip on how to hold the endotracheal tube for better visualization during insertion.

The technique of pre-bending the tube or adjusting it to the angle of the larynx for successful intubation.

Demonstration of the intubation process using a video laryngoscope and the importance of proper head positioning.

Transcripts

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