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Preamble
Endotracheal Tube (ETT) general anaesthesia,
intensive care and emergency medicine, for
airway management and mechanical ventilation1
3. Gal TJ. Airway Management. In: Miller RD et all eds. Miller’s Anesthesia, 6th ed. Philadelphia, Elsevier Churchill Livingstone, 2005
History (cont…)
Ivan W.Magill (1888–1986) and Edgar S. Rowbotham
(1890–1979) in 1920’s technique of blind nasal
intubation position "sniffing the morning air” 3
Arthur Guedel (1883–1956) and Ralph M. Waters
(1883-1979) in 1928 promoted the cuffed
endotracheal 3
Murphy eye in 1941 on the side distal tip of the
standard ETT 3
Carlens in 1949 Double-lumen tubes for
Bronchospirometry 3
3. Gal TJ. Airway Management. In: Miller RD et all eds. Miller’s Anesthesia, 6th ed. Philadelphia, Elsevier Churchill Livingstone, 2005
History (cont…)
5. Magill-type endotracheal tube, England, 1981 in Science Museum. Brought to Life: Exploring the History of Medicine. Available
at www.sciencemuseum.org. Accessed on 17th October 2009
Material of ETT
Table 1. Characteristics of materials from which tubes are manufactured 4
4. Mitchell V, Patel A. Tracheal Tubes. In : Calder I, Pearce A eds. Core Topics in Airway Management. New York, Cambridge University
Design of ETT
Preformed curve
anatomy of the pharynx 4
Have 2 end proximal
end (machine end) and
Figure 2. ETT made from PVC 2
distal end (patient end) 7
Bevel 2
Murphy Eye 2
With cuff or uncuff 2
Figure 3. Murphy Eye 2 Figure 4. ETT cuff and uncuff 2
2. Endotracheal Tubes in Anesthesia Physics and Equipment mede easy. Available at www.freshgasflow.com Accessed on 17th October 2009
4. Mitchell V, Patel A. Tracheal Tubes. In : Calder I, et all eds. Core Topics in Airway Management. New York, Cambridge University Press, 2005
7. Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
Sizing of ETT
Internal Diameter Sizing 4
Eksternal Diameter is limeted 3
* Adult level of the glottic aperture
* Children the subglottic (cricoid cartilage)
French size circumference 3
Manufactured in 0.5 mm ID increment from
2.5 – 9.0 mm 3
3. Gal TJ. Airway Management. In: Miller RD et all eds. Miller’s Anesthesia, 6th ed. Philadelphia, Elsevier Churchill Livingstone, 2005.
4. Mitchell V, Patel A. Tracheal Tubes. In : Calder I, Pearce A eds. Core Topics in Airway Management. New York, Cambridge University
Press, 2005
Sizing of ETT (cont…)
Table 2. Comparison of small and large tracheal tubes 4
4. Mitchell V, Patel A. Tracheal Tubes. In : Calder I, Pearce A eds. Core Topics in Airway Management. New York, Cambridge University
Press, 2005
Sizing of ETT (cont…)
Men 7.5 – 9.0 mm ID 6
Women 7.0 – 8.0 mm ID 6
Children
* measuring the diameter of the distal joint of the
index finger of the child or lumen external nares 9
* Calculation of tube sizes according to child’s age 7
- Prematures : 2.5 mm ID
- 0 to 6 months : 3 to 3.5 mm ID
- 6 months to 1 year : 3.5 to 4.0 mmID
6. Morgan GE, Mikhail MS, Murray MJ eds. Airway Management. Clinical Anesthesiology, 4th ed. New York, Lange Medical Books, 2006.
7.Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
9. Ramamani M, Mohanty S, Gupta S. Paediatric Anaesthetic Equipment. In : Jacob R et all eds. Understanding Paediatric Anaesthesia, 2nd
ed. New Delhi, B.I.Publication Pvt Ltd, 2008
Sizing of ETT (cont…)
- Penlington’s formula 9 :
1 to 6 years Age (in years) / 3 + 3.5 mm ID
> 6 years Age (in years) / 4 + 4.5 mm ID
- Cole’s formula for uncuffed tubes 6 :
Age (in years) / 4 + 4 mm ID
3. Gal TJ. Airway Management. In: Miller RD et all eds. Miller’s Anesthesia, 6th ed. Philadelphia, Elsevier Churchill Livingstone, 2005.
Length or Depth of ETT
The Length of the ETT
the end that goes into trachea,
marked in centimeters 2
ETT have black markings
proximal to the cuff 2
Single mark vocal cords at Figure 5. ETT have single mark
black mark 2
Two marks keep vocal
cords between 2
Confirmed by auscultation 2
Figure 6. ETT have 2 mark
2. Endotracheal Tubes in Anesthesia Physics and Equipment mede easy. Available at www.freshgasflow.com Accessed on 17th October 2009
Length or Depth ETT (cont…)
Methods to predict appropriate ETT depth 12
21 cm (females) or 23 cm (males) at corner of mouth
for orotracheal technique
26 cm (females) or 28 cm (males) at nares for
nasotracheal technique
Distance from cricoid to xiphoid
12. Ledrick D, et all. Evaluation of Manual Cuff Palpation to Confirm Proper Endotracheal Tube Depth. Available at
http://pdm.medicine.wisc.edu. Accessed on 17th October 2009
Length or Depth ETT (cont…)
In children, the length oral tube by formula 7
Age (in years) / 2 + 12 cm
In children, length for nasal intubation add
3 cm to oral length 7
Age (in years) /2 + 15 cm
7. Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
Length or Depth ETT (cont…)
A Chest radiograph (CXR) most effective
means of confirming ETT depth 12
12. Ledrick D, et all. Evaluation of Manual Cuff Palpation to Confirm Proper Endotracheal Tube Depth. Available at
http://pdm.medicine.wisc.edu. Accessed on 17th October 2009
ETT cuff and uncuff
The cuff and inflation system
an inflation lumen in the
wall tube, an external inflation
tube, a pilot ballon, and a self-
sealing inflation valve 4
6. Morgan GE, Mikhail MS, Murray MJ eds. Airway Management. Clinical Anesthesiology, 4th ed. New York, Lange Medical Books, 2006.
10. Khine,et all. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology, 1997
14. Mar;86(3):627-31 14. Robin G. Editorial. Should cuffed endotracheal tubes be used routinely in children?. Can J Anesth, 2005
Other Types of Tube
R.A.E (Ring, Adair and
Elwyn) preformed tube 2,7
- South facing : upper
cleft lip and cleft palate
surgery
- North facing : lower lip
surgery
2. Endotracheal Tubes in Anesthesia Physics and Equipment mede easy. Available at www.freshgasflow.com Accessed on 17th October 2009
7. Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
Other Type of Tubes (cont…)
Spiral embeded (flexometallic
armored tube) : non kinkable,
non collapsible 2,7
Microlaryngeal and
laryngotracheal surgery tube 7
Coles tube : for children, distal
end of tubes has narrow
diameter 7 Figure 11. Comparison of armoured
ETT and standard ETT
Endotrol tube : angle of tip can
be changed nasal intubasi 7
2. Endotracheal Tubes in Anesthesia Physics and Equipment mede easy. Available at www.freshgasflow.com Accessed on 17th October 2009
7. Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
Other Type of Tubes (cont…)
Double lumen tubes :
Robertshaw’s and
carlens thoracic
surgery where one lung
Figure 12. Green gordon tube (right sided)
anaesthesia 7 and Robertshaw tube (left sided) 2
Combitube : double
lumen tube patent
airway in emergency and
difficult intubation 7 Figure 13. A. Combitube in esophagus, B. trachea 15
2. Endotracheal Tubes in Anesthesia Physics and Equipment mede easy. Available at www.freshgasflow.com Accessed on 17th October 2009
7. Yadav A ed. Anaesthesia Machine and Equipments. Short Textbook of Anaesthesia, 2nd ed. India, Academa Publishers, 2004
15. Klock PA, Ovassapian A. Airway management. In : Longnecker, et all, eds. Anesthesiology. New York, Mc Graw Hill, 2008