Endotracheal tube is an essential component in practice of
anesthesia. It has been used since 1800s. it is important for maintenance the
airway, facilitate using of inhalation anesthetics agents and allow for suctioning
secretion. Endotracheal tubes are flexible, long and hollow tubes made of
transparent plastic PVC. most tubes are coming with inflatable cuff to seal the
trachea and protect the airway, airway connecter to facilitate a connection
with an airway equipment, and pilot balloon which is a small inflatable balloon
connected to the cuff through a narrow lumen. in addition, it acts like a gauge
for the pressure of the cuff. Endotracheal tubes come in individual packaged
and they are for single used. Types of endotracheal tubes divided into nasal or
oral ETT and cuffed or uncuffed tubes (RAE tube, Reinforced tube, double lumen
tube which is used in thoracic surgery to inflate one lung and deflate another
lung). Standard cuffed endotracheal tubes are coming in variety sizes from 4.5
to 10.5 mm based on patient’s weight and age. They are usually having markings for
guiding the proper depth of insertion, also the tip is designed with “bevel shape” to improve
the view of the vocal cords during intubation and has a convenient side benefit of being slightly harder to be blocked. also,
there is an additional hole called Murphyeye which is basically ensure a
continuous ventilation and allow passage of gas in case of the bevel tip become
obstructed. Additionally, in
X-ray procedures there is a Radiopaque line, it is a blue line that helps to
identify the tube position.  Uncuffed endotracheal tubes are used to minimize
the tracheal trauma in patients younger than 8 years old. This type of tubes
lack of pilot balloon and cuff.  Second
type of endotracheal tube is Rae tube that more curvature than standard tubes.
It is used in orofacial surgeries to provide an unobstructed view, but it is
more difficulty than standard ET tube because it difficult passing a suction
catheter. For thoracic Surgery, it may require lung separation to provide optimal
surgical exposure, so the double lumen tube is the one that has the lung
separating feature. It is used to ventilate one lung and deflate the another
one. it becomes contraindicated in case of difficult airway or in small patient
because It has large tubes. The double lumen endotracheal tube comes in tow
tubes longer tube, transparent tube, is placed in bronchus and shorter tube,
blue tube, placed in trachea. They both have cuffs and pilot balloons. 

In general, Endotracheal tubes are used for airway management
for intubation and ventilation in general anesthesia, or for need of mechanical
ventilation in case of respiratory failure. For oral intubation, it is needed
for providing a way for evacuation secretion of the lung,
provide a patent airway and trauma patient. Nasal intubation is indication in
patient with limited
mouth open. It is more comfort long term intubation than oral intubation and
decrease gagging. Nasotracheal intubation becomes contraindication in
coagulopathy patient because it has a risk of bleeding, also if there is an
obstruction of the nose or tumor and foreign body. 


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