Endotracheal Intubation: Oral and Nasal

  • Gillian Morrison
  • Joshua M. TobinEmail author


  • The indications for airway management include protecting the airway from aspiration, providing adequate oxygenation, and providing adequate ventilation (removing carbon dioxide).

  • Adequate preoxygenation is the key principle to avoiding desaturation during the apneic period associated with rapid sequence induction. Patients should breathe 10 L of oxygen for 2 min or five vital capacity breaths, prior to induction.

  • Simple airway examination can help to determine the likelihood of a difficult airway. A difficult airway is suggested by Mallampati (MP) score III or IV, thyromental (TM) distance <6 cm, limited range of motion of the cervical spine, small chin, overbite, short thick neck, pathology of the airway, and radiation to the neck.
    • Mallampati score when looking into an open mouth:

    • I = able to visualize all of the soft palate

    • II = able to visualize all of the uvula

    • III = able to visualize only the base of the uvula

    • IV = soft palate not visible

  • Further predictors of difficulty with mask ventilation include beard, obesity, no dentition/edentulous, and history of obstructive sleep apnea (OSA).

  • In the event that a potentially difficult airway is identified, then consider expert consultation immediately.

  • The usual size of endotracheal tube used is a #7.0 for adult women and #7.5 for adult men.

  • Endotracheal tube size for children = (age/4) + 4.
    • Children have a more superior and anterior larynx.

    • The pediatric epiglottis can be larger and more “floppy”; therefore consider the use of a Miller (straight) blade.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Keck School of Medicine of USCLos AngelesUSA
  2. 2.Division of Trauma AnesthesiologyKeck School of Medicine of USCLos AngelesUSA

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