Endotracheal Tube Case Study

Q13. Which endotracheal tube you will prefer RAE, flexomettalic or mcintosh? What are the problems associated with these tubes?
Ans- Ideal ET Tube is south facing RAE (Ring Adair Elwin) tube fixed in center over the lower lip.
RAE Endotracheal Tubes are designed to conveniently position the anesthesia circuit out of the surgical field. Problem- Difficult to pass Suction catheter. Fixed curvature hence more chances of endobronchial intubation or inadvertent extubation.
Flexometallic tubes- Inner diameter of tube decreases so airway pressure increases. Permanent kinking of the rings due to retractor pressure leads to permanent obstruction.
Mcintosh tube- Easily compressed with Dingman retractor hence airway pressure increases.
LMA can also be
What must be the position of the child for the surgery?
Ans- Whole body is raised over a thick foam allowing the head to drop back into hyperextended position supported over a head ring. This allows adequate exposure and pooling of blood in to nasopharynx, away from the larynx from where it can be suctioned easily. Figure 3: (a) Thick foam used to raise the torso of child with head hyperextended into a head ring. (b) various Gadgets prepared before inducing the child.
Q13 What additional precautions will you take before commencement of surgery?
Ans- A pharyngeal pack of wet ribbon gauze inserted for cleft lip repair. one end must protrdue from oral cavity so that it can be remembered to remove it after completion of surgery .
Oro gastric tube passed to empty the gastric secretions and aerophagia
Doses of local anaesthetics with adrenaline injected for infraorbital/paltine nerve block or local area must not exceed the maximum allowable drug dosage /kg body weight (lignocaine 5mg/kg, epinephrine 10microgram/kg).
Proper eye padding to prevent exposure keratitis
Q14. What type and amount of fluid you must use in intraoperative
Ketamine may also be used. Check air entry bilaterally and shorten tube as necessary. Exclude mechanical causes by suction. ET suctioning followed by deepening anaesthetic planes with inhalational anaesthetics, nebulization with beta 2 agonist and sub cut adrenaline. Drugs used in the Management of persistent wheezing (a) Beta-2 agonists – salbutamol through breathing circuit– 1 puff=100mcg, nebulised 0.5% solution (5mg/ml) diluted 0.5ml in 4ml or undiluted. (b) Adrenaline 1-2 mcg/kg IV – ask the surgeon to infiltrate quickly (c) Corticosteroids – methyl prednisolone 0.5 -1mg/kg, hydrocortisone 2-4 mg/kg work more slowly than beta-2 agonistenhance and prolong action of beta-2 agonists within 1 hour anti inflammatory effect takes 4-6 hours (d) Lignocaine 1.5mg/kg IV reduces the airway response to instrumentation and drug induced bronchospasm. lignocaine can itself increase airway tone (e) Magnesium (f)Theophyllines – aminophylline and deriphylline are not advised as they cause cardiac dysrhythmias