Understanding Anesthesiology - The Global Regional Anesthesia ...

After intubation, correct placement of the ETT must be
confirmed and esophageal intubation ruled out. The
“gold standard” is direct visualization of the ETT situated
between the vocal cords. The presence of a normal,
stable end-tidal carbon dioxide (CO2) waveform
on the capnograph confirms proper placement except
in the cardiac arrest setting. Both sides of the chest and
the epigastrium are auscultated for air entry. Vapour
observed moving in and out of the ETT is supportive
but not confirmative of correct tracheal placement.
depth of anesthesia. Sore throat is the most common
complication that presents post-extubation and is selflimited.
Airway edema, sub-glottic stenosis, vocal cord
paralysis, vocal cord granulomata and tracheomalacia
are some of the more serious consequences that can occur
and are more common after a prolonged period of
intubation.
If the ETT is advanced too far into the trachea, a right
mainstem intubation will occur. This is detected by noting
the absence of air entry on the left as well as by observing
that the ETT has been advanced too far. The appropriate
distance of ETT insertion, measured at the
lips, is approximately 20 cm for an adult female and 22
cm for the adult male.
Complications may occur during laryngoscopy and intubation.
Any of the upper airway structures may be
traumatized from the laryngoscope blade or from the
endotracheal tube itself. The most common complication
is damage to teeth or dental prosthetics. It is imperative
to perform laryngoscopy gently and not to persist
with multiple attempts when difficulty is encountered.
Hypertension, tachycardia, laryngospasm, raised
intracranial pressure and bronchospasm may occur if
airway manipulation is performed at an inadequate
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