Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps

Nasal intubation is an advantageous approach for dental procedures performed in the hospital, ambulatory surgery center, or dental office, when possible. Although many who provide anesthesia services are familiar and comfortable with nasal intubation techniques, some are reluctant and uncomfortable because of lack of experience or fear of nasopharyngeal bleeding and trauma. It has been observed from experiences in various settings that many approaches may be adapted to the technique of achieving nasal intubation. The technique that is described in this paper suggests a minimally invasive approach that introduces the nasoendotracheal tube through the nasopharyngeal pathway to the oropharynx in an expedient manner while preserving the nasopharyngeal structures, thus lessening nasal bleeding and trauma to soft tissues. The technique uses a common urethral catheter and can be incorporated along with current intubation armamentaria. As with all techniques, some limitations to the approach have been identified and are described in this paper. Cases with limited mouth opening, neck injury, and difficult airways may necessitate alternative methods. However, the short learning curve along with the many benefits of this technique offers the anesthesia professional additional options for excellent patient care.

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Comparison of a tube core and Magill forceps for nasotracheal intubation: a randomised controlled trial

10.21203/rs.3.rs-72103/v3 ◽

2021 ◽

Author(s):

Rui Hu ◽

Jing-Yi Niu ◽

Li-Ning Wu ◽

Hao Sun ◽

Peng Sun ◽

...

Keyword(s):

Controlled Trial ◽

Demographic Data ◽

Nasotracheal Intubation ◽

Clinical Trial Registry ◽

Magill Forceps ◽

Paraffin Oil ◽

Significant Difference ◽

Oral Tissue ◽

Randomised Controlled ◽

Patient Enrolment

Abstract Background: Magill forceps are frequently used to complete nasotracheal intubation (NTI). We aimed to identify a tube core that could conveniently facilitate the NTI process without using Magill forceps.Methods: Sixty patients scheduled for oral and maxillofacial surgeries were enrolled in our study and divided into two groups (30 per group) with no differences with regard to demographic data. In the Magill forceps group (Group M), a wire-reinforced endotracheal catheter was inserted into the trachea using Magill forceps. However, in the tube core group (Group T), a tube core bent to the physiological curve of the nasal cavity and lubricated with aseptic paraffin oil was inserted into the endotracheal catheter and was then withdrawn after the endotracheal catheter was advanced through the glottis under direct vision.Results: All NTIs were completed successfully, and Magill forceps were not used on any patient in Group T. There was a significant difference in total NTI time between the two groups (Group M, 59.7 (5.1) sec vs Group T, 52.4 (3.1) sec). Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T (6/30 vs 5/30, respectively). No damage to oral tissue or teeth was observed in either group.Conclusions: We conclude that using a tube core, consisting of a disposable sterilised stylet, is a convenient choice for NTI.Trial registration: Patient enrolment was conducted after registration in the Chinese Clinical Trial Registry (www.Chictr.org.cn, ChiCTR1900027387). This trial was prospectively registered on 11 November 2019.

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Use of McGrath<sup>®</sup> MAC Video Laryngoscope for Nasotracheal Intubation in Patients for Whom Intubation Was Expected to Be Difficult Due to the Limited Mouth Opening

Open Journal of Anesthesiology ◽

10.4236/ojanes.2018.87023 ◽

2018 ◽

Vol 08 (07) ◽

pp. 223-227

Author(s):

Aiji Sato ◽

Naoko Tachi ◽

Yoko Okumura ◽

Mayumi Hashimoto ◽

Masahiro Yamada ◽

...

Keyword(s):

Nasotracheal Intubation ◽

Mouth Opening ◽

Video Laryngoscope ◽

Limited Mouth Opening

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Comparison with Tube Core and Magill forceps for Nasotracheal Intubation: A Randomized Controlled Trial

10.21203/rs.3.rs-72103/v1 ◽

2020 ◽

Author(s):

Rui Hu ◽

Jingyi Niu ◽

Lining Wu ◽

Hao Sun ◽

Peng Sun ◽

...

Keyword(s):

Tracheal Tube ◽

Controlled Trial ◽

Liquid Paraffin ◽

Demographic Data ◽

Nasotracheal Intubation ◽

Clinical Trial Registry ◽

Magill Forceps ◽

Randomized Controlled ◽

Significant Difference ◽

Oral Tissue

Abstract Background: Magill forceps are frequently used to complete the process of nasotracheal intubation (NTI). We aimed to identify a tube core that could facilitate the NTI process conveniently without Magill forceps. Methods: Sixty patients with no differences between the two groups (30 per group) with regard to demographic data were enrolled in our study. In Group M, the wire-reinforced tracheal tube was inserted into the trachea using Magill forceps. However, in Group T, a tube core bent to the physiological curve of the nasal cavity lubricated with aseptic liquid paraffin was inserted into the tracheal tube, and the tube core was then withdrawn after the tracheal tube was advanced through the glottis under direct vision. Results: All NTIs were completed successfully, and no Magill forceps were used in Group T. There was a significant difference in total NTI time between the two groups (Group M, 59.7 (5.1) sec vs Group T, 52.4 (3.1) sec). Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T (6/30 vs 5/30, respectively). There was no presence of damaged oral tissue or damage to the teeth in either group. Conclusion: We conclude that using the tube core, which is a disposable sterilised stylet, for NTI is a convenient choice. Trial registrations: This clinical research was registered at the Chinese Clinical Trial Registry (www.Chictr.org.cn, ChiCTR1900027387).

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BLIND NASOTRACHEAL INTUBATION

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.04.4949 ◽

2006 ◽

Vol 13 (04) ◽

pp. 669-675

Author(s):

ZAHID MEHMOOD CHEEMA ◽

MANZAR ZAKARIA ◽

NOMAN ALI MALIK

Keyword(s):

Patient Safety ◽

Adverse Events ◽

Endotracheal Tube ◽

Elective Surgery ◽

Randomized Study ◽

Nasotracheal Intubation ◽

Mouth Opening ◽

Inhalational Anesthesia ◽

Significant Difference ◽

Group 2

Objective: Blind Nasotracheal Intubation (BNI) can be undertaken aftermuscle relaxation with Inj. Succinylcholine or under deep inhalational anesthesia. The objective of study was todetermine the preferred one of these 2 techniques of BNI. Design: Prospective, randomized study. Place andDuration of Study: PNS SHIFA, Karachi and AFID, Rawalpindi from May 2002 to April 2005. Subjects and Methods:Sixty patients between 10 - 40 years of age presenting for elective surgery in whom BNI was required due to limitedor no mouth opening were enrolled through convenient sampling. Patients were randomly divided into two groups:WMR (n=30) or NMR (n=30) to undergo BNI after relaxation with Succinylcholine or under inhalational anesthesia with2% Halothane, respectively. A red rubber nasal endotracheal tube (cuffed and un cuffed in adults and childrenrespectively) was used. Results: The frequency of successful BNI in WMR group was 100% and significantly higher(P=0.03) than in the NMR group (86%). Time to succeed was significantly less in the WMR group 2±0.9 minutes versus3.4±2.0 in the NMR group. There was no statistically significant difference of occurrence of adverse events in the twogroups. Conclusion: BNI with Succinylcholine produced a higher success rate. This technique can decrease failureto intubate, we speculate that it may, therefore, increase patient safety.

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Comparison with tube core and Magill forceps for nasotracheal intubation: a randomized controlled trial

10.22541/au.160638138.82358073/v1 ◽

2020 ◽

Author(s):

Rui Hu ◽

Jingyi Niu ◽

Lining Wu ◽

Hao Sun ◽

Peng Sun ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Nasal Cavity ◽

Controlled Trial ◽

Demographic Data ◽

Nasotracheal Intubation ◽

Magill Forceps ◽

Randomized Controlled ◽

Paraffin Oil ◽

Significant Difference ◽

Oral Tissue

Objective: Magill forceps are frequently used to complete the process of nasotracheal intubation (NTI). We aimed to identify a tube core that could facilitate the NTI process conveniently without Magill forceps. Methods: Sixty patients scheduled for oral and maxillofacial surgeries with no differences between the two groups (30 per group) with regard to demographic data were enrolled in our study. In Group M, the wire-reinforced endotracheal catheter was inserted into the trachea using Magill forceps. However, in Group T, a tube core bent to the physiological curve of the nasal cavity lubricated with aseptic paraffin oil was inserted into the endotracheal catheter, and it was then withdrawn after the endotracheal catheter was advanced through the glottis under direct vision. Results: All NTIs were completed successfully, and no Magill forceps were used in Group T. There was a significant difference in total NTI time between the two groups (Group M, 59.7 (5.1) sec vs Group T, 52.4 (3.1) sec). Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T (6/30 vs 5/30, respectively). There was no presence of damaged oral tissue or damage to the teeth in either group. Conclusion: We conclude that using the tube core, which is a disposable sterilised stylet, for NTI is a convenient choice.

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