a. Increased secretions

(1) Necessitating more frequent suctioning

(2) Loosening of tape

b. Infant activity

c. Procedures requiring repositioning infant

d. Tube slippage

E. Technique (See also Endotracheal

Intubation on the Procedures

Website, and Appendix D for

Techniques of Intubation Specific to

Unique Patient Needs) Orotracheal

Intubation (Table 36.2)

1. Position infant with the head in midline and the neck

slightly extended, pulling chin into a “sniff” position

(Fig. 36.4). The head of the infant should be at operator’s eye level.

It may be helpful to place a roll under the baby’s

shoulders to maintain slight extension of the neck.

2. Put on gloves.

3. Clear oropharynx with gentle suctioning.

4. Empty stomach.

5. Bag-and-mask ventilate and preoxygenate infant as indicated by clinical condition. Follow heart rate and oxygenation.

6. Turn on the laryngoscope light, and hold the laryngoscope in left hand with thumb and first three fingers,

with the blade directed toward patient.

a. Put thumb over flat end of laryngoscope handle.

b. Stabilize the infant’s head with right hand.

The laryngoscope is designed to be held in the

left hand, by both right- and left-handed individuals. If held in the right hand, the closed, curved part

of the blade may block the view of the glottis, as

well as make insertion of the endotracheal tube

impossible.

7. Open infant’s mouth and depress tongue toward the left

with the back of right forefinger (Fig. 36.5).

a. Continue to steady head with third fourth and fifth

fingers of right hand.

b. Do not use the laryngoscope blade to open mouth.

8. Under direct visualization, insert the laryngoscope

blade, sliding over the tongue until the tip of the blade

A B

Fig. 36.3. A: Normal epiglottis obscuring glottis. This amount of clear secretions does not require suctioning for visualization. B: Same airway as in Figure 36.1 after surgical removal of cyst. Glottic opening is

visible just beneath epiglottis. Gentle tracheal, pressure, or decreasing neck extension while lifting tip of

laryngoscope blade, will improve visibility.

Fig. 36.4. Appropriate sniff position for intubation. Note that

the neck is not hyperextended; the roll provides stabilizing

support.