## Endotracheal Intubation Complications ### Timing of Tracheal Stenosis **Key Point:** Tracheal stenosis is a **late complication** that develops weeks to months after extubation, NOT within 48 hours. Early complications (within 48 hours) include laryngeal edema, sore throat, and hoarseness. **High-Yield:** Tracheal stenosis typically manifests 3–8 weeks post-extubation and results from chronic ischemic injury, fibrosis, and scarring of the tracheal mucosa caused by prolonged cuff pressure exceeding capillary perfusion pressure (>25 cm H₂O). ### Comparison of Intubation Route Complications | Complication | Orotracheal | Nasotracheal | Notes | |---|---|---|---| | Sinusitis | Rare | Common | Nasal tube obstructs sinus drainage | | Dental trauma | More common | Rare | Laryngoscope blade contact | | Tube kinking | More common | Rare | Sharper angle at teeth | | Epistaxis | Absent | Possible | Nasal trauma during insertion | **Clinical Pearl:** Nasotracheal intubation carries a higher risk of maxillary and ethmoid sinusitis due to obstruction of the nasal airway and impaired mucociliary clearance. ### Tube Obstruction **Key Point:** Smaller diameter tubes have a **higher resistance to airflow** and are more prone to obstruction by secretions, blood, or kinks. This is governed by Poiseuille's law: resistance is inversely proportional to the fourth power of the radius. ### Laryngeal Edema Prevention **Key Point:** Laryngeal edema is preventable by: - Using appropriately sized tubes (minimal leak technique: 20–25 cm H₂O) - Maintaining cuff pressure ≤25 cm H₂O - Minimizing tube movement and duration of intubation - Gentle intubation technique [cite:Gupta & Sharma Anesthesia Ch 24]
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