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Adverse effects of Endotracheal Intubation 13/9/10 Can be classified anatomically or into immediate, short and long term complications. Below is anatomically. AIRWAY Dental Trauma Failure to Intubate - careful assessment of risk factors (history, examination, previous intubations) - optimal positioning - having a back up plan to provide oxygenation (bagging, LMA, guedels, nasopharyngeal airways, trans-tracheal airways) Failure to Ventilate or Oxygenate - see above Damage to airway (cord injury, false passage creation) - multiple laryngoscopies intubation for a prolonged length of time limit laryngoscopies have a back up plan gentle manipulation with airway devices Oesophageal intubation - ETCO2 use Subglottic stenosis - assessment for early extubation - vigilant cuff pressure measurement - early tracheostomy Tracheo-oesophageal Fistula - see subglottic stenosis above RESPIRATORY Endobronchial intubation - careful attention on insertion - clinical assessment after intubation - CXR Jeremy Fernando (2011) Aspiration - aspiration of N/G tubes starve if able prokinetics rapid sequence induction Bronchospasm - if occurs can treat with: salbutamol, adrenaline, ketamine, Mg Hypoxia from de-recruitment of lungs - conversion from spontaneous ventilation -> positive pressure ventilation results in derecruitment when patient apnoeic - preoxygenation - quick securement of airway - increasing PEEP on ventilator Sputum retention + pneumonia - head up suction chest physio early antibiotics Barotrauma - protective lung ventilation CARDIOVASCULAR Hypotension (cardiovascular collapse) - multi-factorial: drug induced, patient often have high sympathetic tone which is obtunded with induction of anaesthesia - use of balanced, haemodynamically stable agents for induction - judicious use of vasoactive medications - assess for tension pneumothorax and decompress if indicated Hypetension and Myocardial Ischaemia - from laryngoscopy and tracheal stimulation - balanced anaesthetic on induction NEUROLOGICAL Increased ICP - obtund haemodynamic response to laryngoscopy with hypnotic and fasting acting opioid Potential spinal cord injury on laryngoscopy in patient with an unstable cervical spine - inline immobilisation - awake fiberoptic intubation Jeremy Fernando (2011) Requirement for sedation and analgesia OTHER Adverse drug reactions Bacteraemia Requirement for close monitoring (one-one nursing care) Jeremy Fernando (2011)