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Tracheal Intubation

Intubation being practiced on a dummy (conventional technique using a laryngoscope) In medicine, intubation is the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopic procedures, it is most often used to denote tracheal intubation. In tracheal intubation, an endotracheal tube is passed through the nose or mouth, through the larynx, and into the trachea.

Tracheal intubation is performed in various medical conditions:

  • In comatose or intoxicated patients who are unable to protect their airways. In such patients, the throat muscles may lose their tone so that the upper airways collapse and air can not pass to the lungs. Furthermore, protective airway reflexes such as coughing and swallowing, which serve to protect the lower airways against aspiration of secretions and foreign bodies, may be absent. With tracheal intubation, airway patency is restored and the lower airways can be protected from aspiration.
  • In general anesthesia. In anesthetized patients spontaneous respiration may be decreased or absent due to the effect of anesthetics, opioids, or muscle relaxants. To enable mechanical ventilation, an endotracheal tube is often used, although there are alternative devices such as face masks or laryngeal masks.
  • In diagnostic manipulations of the airways such as bronchoscopy.
  • In endoscopic operative procedures to the airways such as laser therapy or stenting of the bronchi.
  • In intensive care medicine for patients who require respiratory support.
  • In emergency medicine, particularly for cardiopulmonary resuscitation.

Tracheal intubation can be performed by direct laryngoscopy (conventional technique), in which a laryngoscope is used to obtain a view of the glottis. A tube is then inserted under direct observation. This technique can only be employed if the patient is comatose or under general anesthesia. An alternative is intubation under local anesthesia using a flexible endoscope.

There are various types of tracheal tubes for oral or nasal intubation. Tubes may be either flexible or preformed and relatively stiff. Most tubes have an inflatable cuff to seal the lower airways against air leakage and aspiration of secretions.

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