Endotracheal intubation prevention

Intubation and mechanical ventilation increase the risk of HAP/VAP 6- to 21 -fold.2,22 VAP also may be related to colonization of the ventilator circuit23 Risk of aspiration is increased in these patients owing to the supine positioning of the patient, the presence of the endotracheal tube preventing closure of the... 

Epidural/Intrathecal administration Limit epidural or intrathecal administration of preservative-free morphine and sufentanil to the lumbar area. Intrathecal use has been associated with a higher incidence of respiratory depression than epidural use. Asthma and other respiratory conditions The use of bisulfites is contraindicated in asthmatic patients. Bisulfites and morphine may potentiate each other, preventing use by causing severe adverse reactions. Use with extreme caution in patients having an acute asthmatic attack, bronchial asthma, chronic obstructive pulmonary disease or cor pulmonale, a substantially decreased respiratory reserve, and preexisting respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Reserve use for those whose conditions require endotracheal intubation and respiratory support or control of ventilation. In these patients, consider alternative nonopioid analgesics, and employ only under careful medical supervision at the lowest effective dose. 

Ketamine relaxes smooth muscles in the airways and may therefore be a useful induction agent in children with asthma (6). If endotracheal intubation is required, lidocaine 1-2 mg/kg intravenously before intubation has been recommended, although the use of a laryngeal mask airway may be more appropriate. When used in combination with midazolam by infusion, ketamine provides analgesia and prevents and relieves bronchospasm (7). 

Zimmerman AA, Funk KJ, TidweU JL. Propofol and alfentanU prevent the increase in intraocular pressure caused by succinylchohne and endotracheal intubation during a rapid sequence induction of anesthesia. Anesth Analg 1996 83(4) 814-17. 

Because emergency endotracheal intubation would be performed in a contaminated area, certain measures must be followed to prevent further contamination of the patient. 

B. Perform endotracheal intubation if personnel trained in the procedure are available. Intubation of the trachea provides the most reliable protection of the ainvay, preventing aspiration and obstmcfion and allowing for mechanically assisted ventilation. However, it is not a simple procedure and should be attempted only by those with training and experience. Complications include vomiting with pulmonary aspiration local trauma to the oropharynx, nasopharynx, and larynx inadvertent intubation of the esophagus or a main-stem bronchus and failure to intubate the patient after respiratory arrest has been... 

Respiratory Intravenous lidocaine is commonly used as part of anesthetic induction, especially in children, to prevent reflex bronchoconstriction caused by endotracheal intubation. Intravenous lidocaine significantly improves intubating conditions when it is used as part of inhalational induction. However, intravenous lidocaine can cause reduced airway diameter in... 

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