Intubation Guideline


  • Skilled assistance is mandatory; where possible a team of 4 is required.

  • "Intubator" who controls and co-ordinates the procedure.

  • "Drug administration"

  • A person to apply in-line traction where the stability of the cervical spine is unclear.

  • "Cricoid Pressure"

      • Cricoid pressure is recommended in all emergency situations and should be applied at the commencement of induction.

      • Cricoid pressure may distort the larynx so that intubation is made more difficult.  It should be modified at the discretion of the Intubator, and requires an understanding of the procedure.



  • Induction agent:

      • eg;  Etomidate (0.2mg/kg, 10-20mgs is recommended), or midazolam and morphine or Fentanyl
  • Muscle Relaxant

    • Suxamethonium 1-2mg/kg (100mg)

    • Consider rocuronium 1-2mg/kg (50-100mg) if suxamethonium contra-indicated, eg;

        • Burns patients >48 post injury

        • Spinal injury patients where spasticity is present

        • Chronic neuromuscular disease (Myasthenia Gravis, GBS)

        • Hyperkalaemic states

  • Miscellaneous Drugs

    • Atropine 0.6 – 1.2mg

    • Adrenaline 10ml of 1:10 000 solution

    • Ephedrine 30mgs in 10mls normal saline

  • Procedure – Rapid sequence induction and Orotracheal intubation

      • Pre-oxygenate for 3-4 minutes with 100% oxygen.  Patients receiving non-invasive ventilation should continue on this form of ventilation until the point of induction, and a PEEP valve applied to the AMBU-bag mask assembly.

      • Administer induction agent and suxamethonium

      • Apply cricoid pressure

      • Intubation under direct visualization

      • Inflate ETT cuff until there is no air leak during ventilation

      • Confirm ETT placement with capnographs and chest auscultation with normal ventilation

      • Release cricoid pressure (once tube position confirmed)

      • Secure ETT at correct length

      • Do not cut ETT

      • Connect patient to ventilator

      • Ensure adequate sedation and analgesia to cover period of muscle relaxant and continue as indicted by clinical scenario

      • Insert naso-/-orogastric tube if not already present

      • If ongoing relaxant required use pancuronium or rocuronium

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Page last reviewed: 13 May 2014