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Tracheal intubation
Last reviewed: 04.07.2025
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For direct laryngoscopy and tracheal intubation in newborns, as well as in adults, premedication, anesthesia and muscle relaxation are necessary. Muscle relaxants are not used only for intubation in children weighing less than 1000 g, and also when difficult intubation is expected (Turner syndrome, Pierre Robin syndrome).
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Options for drug support of intubation
- atropine 10-30 mcg/kg, intravenously, trimeperidine 0.5-1.0 mg/kg, intravenously, after 3-5 min suxamethonium iodide 1.5-3.0 mg/kg, intravenously,
- fentanyl 2 mcg/kg, intravenously, over 30 sec, suxamethonium iodide 2.0 mg/kg, intravenously,
- trimeperidine (promedol) 0.75 mg/kg, intravenously, midazolam 0.15 mg/kg, intravenously, after 3-5 minutes - intubation.
- The position during intubation is the “sniffing” position; a cushion is not placed under the shoulders; a typical mistake is overextending the head.
The internal diameter of the endotracheal tube for body weight <1250 g (32 weeks) is 2.5 mm, 1250-3000 g (32-38 weeks) is 3.0 mm, >3000 g (>38 weeks) is 3.5 mm.
The endotracheal tube is passed behind the vocal cords by 2-3 cm. The narrowest point is not the glottis, as in adults, but the subglottic space. X-ray control is necessary to identify the position of the tube; the end of the tube should be projected below the line connecting the ends of the clavicles, at the level of the ThII-ThIII vertebrae.
It is important to remember that when bending, unbending or turning the head, the endotracheal tube moves approximately 2 cm from the midline position, which, with a total trachea length of 4-5 cm, can lead to one-lung tracheal intubation or extubation.