After the glottis were exposed by laryngoscope under direct vision, the catheter was inserted into the trachea through the mouth.

(1) First, tilt the patient's head backward. If the patient's mouth is not open, you can point your thumb at the lower dentition with your right hand, point your finger at the upper dentition, and open your mouth with rotational force.

(2) Put the laryngoscope into the mouth with the left hand from the right corner, push the tongue to the left, slowly push it forward to expose the uvula, then move forward slightly, so that the front end of the bent laryngoscope peep piece enters the epiglottic angle at the base of the tongue, and then lift the laryngoscope upward and forward with the strength of the left arm to increase the tension of the epiglottic ligament of the hyoid and expose the glottis. If it is a straight laryngoscope, its front end should provoke epiglottis and expose the glottis.

(3) When the glottis are clearly revealed, hold the middle and upper section of the catheter with the thumb, forefinger and middle finger of the right hand, so that the front end of the catheter enters the mouth from the right corner, and then move the tube end to the laryngoscope until the catheter approaches the larynx. At the same time, the direction of the catheter is monitored with both eyes through the narrow gap between the lens and the tube wall, and the tip of the catheter is inserted into the glottis accurately and lightly. When inserting a catheter with the help of a tube core, after the tip of the catheter enters the glottis, the tube core should be pulled out first, and then the catheter should be inserted into the trachea. The depth of catheter insertion into trachea is 4 ~ 5 cm for adults, and the distance from the tip of catheter to incisors is 18 ~ 22 cm. Place the dental pad and exit the laryngoscope.

2. Nasal intubation.

This method is basically the same as oral intubation, but there are the following differences.

(1) Liquid paraffin was dripped into nasal cavity before intubation, and lubricant was applied to the front end of catheter. Conscious intubation requires anesthesia on the inner surface of nasal cavity.

(2) Master the operation essentials of pushing the catheter along the inferior nasal meatus, that is, the catheter must be inserted into the nostril in the direction perpendicular to the face, and then exit the retronasal orifice to the pharyngeal cavity along the bottom of the nose. It is forbidden to push the catheter to the top of the head, otherwise it will easily cause serious bleeding.

(3) The distance from the alar to the earlobe is equivalent to the distance from the nostril to the retropharyngeal cavity. When the catheter is advanced to the above distance, hold the laryngoscope with your left hand to expose the glottis. Continue to push the catheter into the glottis with your right hand. If there is any difficulty, you can clamp the front end of the catheter with intubation forceps and send it into the glottis.

(4) Transnasal catheter is prone to buckling at the posterior nasal orifice, which is difficult to handle. Therefore, it is necessary to check the texture of the catheter in advance and choose a tough and elastic catheter, which is not easy to bend and flatten.

3. Blind probe intubation through nose

When the field of vision is not bright, insert the endotracheal tube into the trachea through the nasal cavity.

(1) First, check that the nasal cavity is unobstructed and there is no abnormality. When intubating, you must keep a large amount of air to breathe spontaneously, and you can judge the direction of the catheter according to the strength of exhaled air flow.

(2) Use 1% tetracaine as internal surface anesthesia of nasal cavity, and drip 3% ephedrine to constrict nasal mucosa blood vessels, so as to increase nasal cavity volume and reduce bleeding.

(3) Choose an endotracheal tube with appropriate diameter, coat paraffin oil or local anesthetic ointment on the outside of the tube, hold the tube in your right hand and feed it slowly through your nostrils. It is necessary to judge the position and distance between the oblique mouth end of the catheter and the glottis by the sound intensity or absence of breathing airflow in the catheter. The more the catheter mouth faces the glottis, the louder the air flow sound; On the contrary, the farther away from the glottis, the lighter or no sound. At this time, the surgeon adjusts the head position with his left hand, palpates the skin in the anterior cervical region, and knows the position of the front end of the catheter. Adjust the position of the front end of the catheter with your right hand and listen to the sound of airflow with your ears. When it is adjusted to the loudest part, slowly push the catheter into the glottis.

(4) Fast derivation of the tube when the glottis are open. When the catheter enters the glottis, the propulsion resistance decreases and the exhaled airflow is obvious. Sometimes patients have cough reflex. When the anesthesia machine is connected, it can be seen that the breathing sac expands and contracts with the patient's breathing, indicating that the catheter is inserted into the trachea.

(5) If the exhaled airflow disappears after the catheter is pushed, it is the performance of inserting into the esophagus. The catheter should be retreated to the nasopharynx, and the tip of the catheter should be tilted upward by slightly tilting the head, so that it can be inserted at the glottis.

4. Conscious tracheal intubation

Spray 1% tetracaine on the throat and trachea for mucosal surface anesthesia, and intubate the trachea when the patient is conscious, which is called "conscious tracheal intubation" or "conscious intubation" for short. When the patient's general anesthesia intubation is not safe enough, he can choose conscious intubation.

(1) Surface anesthesia Before conscious intubation, it is required to have perfect mucosal surface anesthesia for the upper respiratory tract, including laryngeal mucosal surface anesthesia and tracheal mucosal surface anesthesia.

(2) Conscious oral or nasal intubation requires patients to be fully calm and relax muscles, which is not only helpful for intubation, but also can basically avoid unpleasant memories after operation.

(3) Preparation of the patient ① The patient must be properly explained, and the key points are coordination matters, such as relaxing the muscles of the whole body, especially the muscles of the neck, shoulders and back, without exerting force and moving; Keep breathing deeply, breathe slowly, don't hold your breath, don't feel sick, etc. , and strive to win the full cooperation of patients; ② Proper medication before anesthesia can reduce the secretion of patients, weaken the reflex of calming the throat, and be beneficial to awake intubation.

(4) 1 ~ 2 minutes After the surface anesthesia of laryngotracheal mucosa is completed, awake tracheal intubation can be performed according to the oral intubation method.