A. E. Mureşan 1, Loredana Duţă 2, D. Alexianu 2, L. Ţiganiuc 2, R. Macovei 2
1 Centre Universitaire Hospitalier Amiens, Pole Anesthesie – Reanimation, France
2 Spitalul Clinic de Urgenţă, Secţia Anestezie – Terapie Intensivă, Bucureşti
Abstract
Management of the airways is the most important task of the anaesthesiologist; it can be performed by the classic approach of the intubation manoeuvre or by tracheostomy. There are several devices for this procedure: endotracheal tubes and tracheostomy cannulas. In this paper are reviewed the methods necessary for endotracheal intubation. The complications of classical intubation are described and classified by the moment of appearance: early and late. The pathophysiology is related to the structure of the tracheal wall and the most important layer, the mucosae and its capillaries. The inner cuff pressure can exceed the perfusion pressure and ischemia occurs; this a frequent condition (over 60%) leading to stenosis and tracheo-esophageal fistulae. In the mean time underinflation of the cuff lead to aspiration syndrome and leakage. We performed in our Neurosurgical ICU a program by routine cuff pressure measurement and recording in the chart of these values; the purpose was to obtain the minimal pressure, necessary to prevent all kind of complications due to overinflation and underinflation.