By Pat Sullivan
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Additional info for Anaesthesia for Medical Students
It may be difficult to obtain an adequate seal using a face mask in patiel~tswith no teeth or with a full beard. The LMA is particularly useful in these patients, providing a good seal and an unobstructed ainvay. i"lticlt patients are not suitable for a LMA? 1. Patients with risk factors for gastric aspiration.
Indirect confirmation that the trachea is intubated with a tracheal tube includes: listening over the epigastrium for the absence of breath sounds with ventilation, observing the chest to rise and fall with positive pressure ventilation, and listening to the apex of each lung field for breath sounds with ventilation. There are, however, numerous reports of physicians auscultating "distant breath sounds" in each lung field, when the ETT was, in fact, incorrectly placed in the esophagus. Hence, listening to the V: +* Must Know 6 Intubation and Anatomy of the Airway lung fields may reveal bronchospasm or evidence of an endobronchial intubation, but cannot be relied on as absolute proof that the tube is correctly positioned in the trachea.
You explain that patients with profound cardiovascularcollapse requiring emergent intubation, do not need any anaesthetic medications such as thiopental or succinylcholine to perform tracheal intubation. In fact the administration of thiopental could have a detrimental result by further depressing his already compromised myocardium. If your colleague asks what other medications can be given through the EIT,tell him to remember the word NAVEL'. This stands for the drugs: Naloxone, Atropine, Ventolin, Epinephrine, and Lidocaine, all of which can be given through an E'IT.