Intubation of the trachea
Last reviewed: 23.04.2024
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For direct laryngoscopy and intubation of the trachea in newborns, as in adults, premedication, anesthesia and muscle relaxation are necessary. The muscle relaxants are not used only for intubation in children weighing less than 1000 g, and when difficult intubation is expected (Turner syndrome, Pierre Robin syndrome).
[Variants of medicamentous maintenance of intubation
- Atropine 10-30 mcg / kg, intravenously, trimiperidine 0.5-1.0 mg / kg, intravenously, 3-5 min of suxamethonium iodide 1.5-3.0 mg / kg, intravenously,
- fentanyl 2 μg / kg, intravenously, for 30 s, suksamethonium iodide 2.0 mg / kg, intravenously,
- trimesteridine (promedol) 0.75 mg / kg, intravenously, midazolam 0.15 mg / kg, intravenously, after 3-5 min - intubation.
- The position of intubation posture "sniffing", the platen under the shoulders do not lay, a typical mistake - perezgibanie head.
The internal diameter of the endotracheal tube with body weight <1250 g (32 weeks) - 2.5 mm, 1250-3000 g (32-38 weeks) - 3.0 mm,> 3000 g (> 38 weeks) - 3.5 mm.
The endotracheal tube is held behind the vocal cords for 2-3 cm. The narrowest place is not the voice gap, as in adults, but the subglottic space. To identify the position of the tube, X-ray control is necessary, the end of the tube should be projected below the line connecting the ends of the clavicles at the level of the vertebrae of ThII-ThIII.
It should be remembered that with flexion-extension or rotation of the head, the endotracheal tube is displaced approximately 2 cm from the median position, which, with a total tracheal length of 4-5 cm, can result in a single-pulmonary intubation of the trachea or extubation.