OVERVIEW
- 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
- 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 de-recruitment 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
- Requirement for sedation and analgesia
OTHER
- Adverse drug reactions
- Bacteraemia
- Requirement for close monitoring (one-one nursing care)
Hi Doc. Tnx for your article! I’ve translate into Italian language here http://www.amicidel118.org/?p=626 tell me if I have to correct something, thanks.
P. Formentini ER Nurse