Experience Summary

In this experience, watch as the anaesthetic team intubate a patient.

Clinical Context

Endotracheal intubation is a core airway management skill performed to secure the airway, enable ventilation, and protect against aspiration. It is commonly undertaken in emergency, critical care, and anaesthetic settings. The process requires careful preparation, systematic execution, and confirmation of correct tube placement.

Procedure of Intubating

The process begins with assessment and preparation. A rapid airway assessment (e.g. mouth opening, Mallampati score, neck mobility) helps predict difficulty. Equipment must be checked, including laryngoscope (direct or video), appropriately sized endotracheal tubes, suction, bougie, and capnography. Monitoring should include ECG, pulse oximetry, blood pressure, and end-tidal CO₂. Preoxygenation with 100% oxygen for 3–5 minutes is essential to increase oxygen reserves and delay desaturation during apnoea. Induction typically follows a rapid sequence induction (RSI) approach in at-risk patients. Intravenous agents such as propofol, ketamine, or etomidate are used for induction, followed by a neuromuscular blocker such as rocuronium or suxamethonium. Cricoid pressure may be applied depending on local practice. The aim is to achieve rapid unconsciousness and optimal intubating conditions while minimising aspiration risk. Laryngoscopy is then performed to visualise the vocal cords. Using a laryngoscope, the tongue is displaced and the epiglottis lifted to expose the glottic opening. The endotracheal tube is advanced through the vocal cords under direct or video guidance. Adjuncts such as a bougie may assist if the view is suboptimal. Once inserted, the cuff is inflated to secure the airway. Confirmation of correct placement is critical. The gold standard is continuous waveform capnography, demonstrating persistent end-tidal CO₂. Additional signs include bilateral chest expansion, auscultation of breath sounds, and absence of gastric insufflation. The tube is then secured, and ventilation commenced. Post-intubation management includes reassessment of tube position, adjustment of ventilator settings, and ongoing sedation and analgesia. A chest X-ray may be used to confirm depth in some settings. Complications include oesophageal intubation, dental trauma, hypoxia, aspiration, and haemodynamic instability, all of which require vigilance and prompt management.

Learning Outcomes

1. Observe the procedure of intubating a patient.
2. Understand the key safety steps in the intubation of a patient.
3. Understand the variety and function of drugs used to intubate a patient.

External Resources

• Endotracheal Intubation Techniques - StatPearls
• Basic anaesthetic techniques - Royal College of Anaesthetists