Segment 1 Opening credits. A patient is shown in the process of being anaesthetised using the endotracheal method via the nose. A male patient is also shown and the case for using an oral or nasal route is put forward dependent on the site of the operation. Intertitle: Apparatus. All the equipment is laid out on a table and the camera pans across it. A laryngoscope is handled as well as other useful surgical supplies. Standard rubber tubing is shown in coils; its natural curve is ideal for intubation. An anaesthetist is shown measuring the length of tubing required. There are 13 different widths of tubing available; the size relates to the Magill scale or the French catheter gauge. Metal connections are shown which relate to the gauge of the tubing. The anaesthetist demonstrates the appropriateness of the nasal versus the oral connectors on a patient. Time start: 00:00:00:00 Time end: 00:05:31:19 Length: 00:05:31:19
Segment 2 Intertitle: Care of endotracheal tubes. An operation concludes and the tube is removed. A nurse cleans the tube inside and out. The nurse sterilises the tube for 2 minutes in boiling water; the connectors must be removed beforehand. The correct storage for the tubes is shown. Intertitle: Preparation of tubes for intubation. The tubes and connectors are prepared for use. A lubricant with a surface anaesthetic agent (Nupercaine 5%) has been prepared. Intertitle: Preparation of the patient. A male patient is prepared for anaesthesia. His throat is sprayed. A pillow is positioned and the narrator observes that the position should so be that the patient appears to be sniffing the air. This is also shown diagrammatically. Time start: 00:05:31:19 Time end: 00:09:56:19 Length: 00:04:25:00
Segment 3 Intertitle: Oral intubation. A man is anaesthetised. A laryngoscope is inserted. Insertion is shown diagrammatically as well as the correct positioning of the equipment. This is for the benefit of the beginner. A point of view down the trachea is shown. Views are complemented by diagrams; these are the landmarks for successful intubation. In case blood enters the larynx, the mouth is packed with lengths of gauze Time start: 00:09:56:19 Time end: 00:15:00:00 Length: 00:04:03:06
Segment 4 Intertitle: Use of the inflatable cuff. A tube which has been partially inflated is shown being prepared in a glass tube (to guide the width) and attached to a syringe (the means of inflation). The inflated tube is then inserted down the patient's trachea. Intertitle: Maintenance of anaesthesia. Anaesthesia proceeds; this can either be via a closed/open circuit system or 'in emergencies' an EMO can. Intertitle: Nasal intubation by the 'blind' method. A diagram illustrates the position of the head. Satisfactory respiration is shown by a piece of gauze held and then gently moved by the patient s breath. The clinician must listen carefully to the patient's breathing; intubation is illustrated in slow motion and then repeated in real time. Time start: 00:15:00:00 Time end: 00:19:08:00 Length: 00:04:08:00
Segment 5 Intertitle: Nasal intubation by direct vision. A number of cases are shown where intubation is not straightforward; the message to the viewer is that the anaesthetist must not use force. The laryngoscope is used to retrieve the end of a nasal tube, which is not correctly positioned. Then, once the patient is ready, he is anaesthetised by a tube to the anaesthetic machine or if the open drop method is used, once the tube has been secured with a safety pin (to stop it disappearing down the patient s nose), a gauze mask is positioned over the patient's face (all scenarios are shown). Alternatively, an EMO can is attached. The larynx is packed as before. Intertitle: Extubation. A patient who has undergone a nasal operation is shown. Gauze is unpacked and blood removed. The tube is retained until the patient coughs, this ensures that any residual matter is expelled. Intertitle: Advantages of endotracheal anaesthesia. This is absolute control of the airway. Several patients are shown; the anaesthetist is shown some distance from the patient during surgery. He is with the anaesthetic machine and watching a respiratory bag. Packing is once again shown. Next there is a patient laying on his front being prepared for a craniotomy. During a complex surgical procedure, this method is also noted to maintain strict asepsis. ICI. The End. Time start: 00:19:08:00 Time end: 00:24:05:07 Length: 00:04:57:07