Position for orotracheal intubation?
Correct Answer: Flexion of neck and extension of atlantoccipital joint
Description: Ans. d (Flexion of neck and extension of atlantoccipital joint) (Ref. Head and Neck Surgery - Otolaryngology 3rd/Ch. 58)OROTRACHEAL INTUBATION# Orotracheal intubation is undertaken ideally with the patient in the sniffing position, the patient's neck flexed slightly on the chest, and the head extended slightly on the neck.# A right-handed operator directs a laryngoscope into the right aspect of the mouth with the left hand holding the scope and pushing the tongue to the left.# A Macintosh laryngoscope with a curved blade is directed into the vallecula, and the entire larynx is lifted anteriorly or ventrally to expose the glottis. A Miller laryngoscope with a straight blade is introduced under the epiglottis. It fixes the larynx at the petiole of the epiglottis and lifts the larynx anteriorly to expose the glottis.# Other varieties of laryngoscopes now exist, but the Macintosh and the Miller are the most likely to be found on an emergency cart.# The right hand is used to insert the endotracheal tube, which should not be overly tight in the glottis. In children, an air leak around the tube is desirable.# Slight pressure on the cricoid cartilage by an assistant sometimes helps to visualize the larynx. This maneuver also can help to prevent aspiration of gastric contents by pressing the cricoid cartilage backward against the vertebral column to close the esophagus and help prevent regurgitation. This technique is desirable when a patient has a full stomach.TracheostomyFollowing induction of general anesthesia and endotracheal intubation, the patient is positioned with a combination of head extension and placement of an appropriate sandbag under the shoulders. There should be no rotation of the head. Children's heads should nor be overextended as it is possible to enter the trachea in the fifth or sixth rings under thesecircumstances.REVIEW OF AIRWAY TECHNIQUES (Temporizing/Adjunctive Measures)# Chin lift/jaw thrust to open airway - caveat: no neck extension if suspected C-spine injury# Bag-valve-mask ventilation - probably the most important, yet under-appreciated, skill of airway management. In the ED, when bagging, use a two-hands on the mask technique for a tight seal, and always use an oral airway# Suctioning/removal of foreign bodies# Nasal airway - generally well-tolerated by the temporarily obtunded patient (e.g. post-ictal, post-procedural sedation, intoxicated)# Oral airway - aids in peri-intubation ventilation; not to be used in patient with intact gag reflex# Laryngeal mask airway (LMA) - this device is inserted into the mouth and has a cuff that occludes the hypopharynx. It has a port through which ventilation can then occur. A variation is the Intubating LMA - this allows the insertion of an endotracheal tube via the ventilation port. The LMA is used both as a rescue device in failed intubation, and as a primary airway device# Needle cricothyroidotomy - accomplished by inserting a needle in cricothyroid membrane, and oxygenating the patient using high pressure oxygen source
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Anaesthesia
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