Nasotracheal Intubation

2002 ◽  
Vol 96 (1) ◽  
pp. 51-53 ◽  
Author(s):  
Tom Elwood ◽  
Duane M. Stillions ◽  
Dawn W. Woo ◽  
Heidi M. Bradford ◽  
Chandra Ramamoorthy
Keyword(s):  
Direct Laryngoscopy ◽  
Comparative Studies ◽  
Elective Surgery ◽  
Nasotracheal Intubation ◽  
The Other ◽  
Magill Forceps ◽  
Blinded Observer ◽  
Catheter Technique ◽  
Nasotracheal Tube ◽  
Rubber Catheter

Background Several techniques have been suggested to reduce the trauma of nasotracheal intubation, although no comparative studies exist. The authors evaluated red-rubber catheters as a guide to nasotracheal intubation. Methods Children presenting for elective surgery were randomized to undergo red-rubber catheter-guided nasotracheal intubation or to have the nasotracheal tube alone inserted. After general anesthesia and paralysis with vecuronium, the nares were prepared with topical vasoconstrictor. The nasotracheal tube was softened with warm water. In the catheter-guided group, the nasotracheal tube tip was fitted to the trailing end of the red-rubber catheter, and the two were advanced together. The red-rubber catheter was retrieved from the nasopharynx, disconnected, and removed. In the other group, the nasotracheal tube was advanced blindly into the nasopharynx. In both groups, intubation was then completed during direct laryngoscopy using Magill forceps. A blinded observer swabbed the pharynx and rated the severity of bleeding based on reference photographs. Results Age, weight, snoring history, and difficulty of intubation were not different between groups. Obvious bleeding was lower using the red-rubber catheter technique (10 vs. 29%, P = 0.013), which took longer to perform (74 vs. 56 s, P = 0.02). Conclusions Although the incidence of bleeding in both groups was similar, severity of bleeding was reduced in the catheter-guided group during nasotracheal intubation. Use of a red-rubber catheter may reduce the trauma associated with nasotracheal intubation.

Telescoping Tracheal Tubes into Catheters Minimizes Epistaxis during Nasotracheal Intubation in Children

2007 ◽  
Vol 106 (2) ◽  
pp. 238-242 ◽  
Author(s):  
Stacey Watt ◽  
Don Pickhardt ◽  
Jerrold Lerman ◽  
James Armstrong ◽  
Paul R. Creighton ◽  
...  
Keyword(s):  
Room Temperature ◽  
Nasotracheal Intubation ◽  
Tube Placement ◽  
Dental Surgery ◽  
Magill Forceps ◽  
Catheter Group ◽  
Group 5 ◽  
Median Area ◽  
Rubber Catheter ◽  
The Right

Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. Methods Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. Results The demographics of the three groups were similar. The estimated median area of the gauze in the catheter group that was covered with blood (0%) was significantly less than the areas in the control (40%) and warm (20%) groups. The incidence of clinically relevant bleeding (>or= 40% of the gauze area covered in blood) in the catheter group (5%) was significantly less than in the control (56%) and warm (39%) groups. The incidence of no detectable blood in the catheter group (59%) was significantly greater than in the control (21%) and warm (26%) groups. Conclusions Telescoping the endotracheal tube into a catheter significantly reduces epistaxis in children undergoing nasotracheal intubation.

An Aid to Nasotracheal Intubation in Orthognathic Surgery

1993 ◽  
Vol 30 (3) ◽  
pp. 350-350 ◽  
Author(s):  
David W. Becker ◽  
Craig B. Bass ◽  
Vincent L. Williams
Keyword(s):  
Orthognathic Surgery ◽  
Nasotracheal Intubation ◽  
Nasal Intubation ◽  
Reliable Technique ◽  
Nasotracheal Tube ◽  
Pharyngeal Flap ◽  
Rubber Catheter

An atraumatic and reliable technique of nasal intubation in patients with previous pharyngoplasty or pharyngeal flap is presented. Using the tight and smooth fit of the fluted end of a red rubber catheter over the end of a nasotracheal tube is the technique described.

scholarly journals Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation

2020 ◽  
Vol 67 (4) ◽  
pp. 193-199
Author(s):  
Brett J. King ◽  
Ira Padnos ◽  
Kenneth Mancuso ◽  
Brian J. Christensen
Keyword(s):  
Direct Laryngoscopy ◽  
Primary Outcome ◽  
Nasotracheal Intubation ◽  
Maxillofacial Surgery ◽  
Controlled Clinical Trial ◽  
Oral And Maxillofacial Surgery ◽  
Magill Forceps ◽  
Parallel Group ◽  
Time Required ◽  
Mean Time

This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. The secondary outcomes included the success of first attempt at intubation and the use of Magill forceps. Results demonstrated a mean time to intubation of 142 seconds in the DL group and 94 seconds in the VL group (p = .011). First attempt intubation success was 92.0% in the VL group and 84.0% in the DL group (p = .34). The use of Magill forceps was significantly increased in the DL group (p = .007). VL for routine nasotracheal intubation in oral and maxillofacial surgery procedures results in significantly faster intubation times and decreased use of Magill forceps compared with traditional DL.

scholarly journals Nasotracheal Intubation Using the Airtraq Versus Macintosh Laryngoscope: A Manikin Study

2008 ◽  
Vol 55 (3) ◽  
pp. 78-81 ◽  
Author(s):  
Yoshihiro Hirabayashi ◽  
Norimasa Seo
Keyword(s):  
Direct Laryngoscopy ◽  
Macintosh Laryngoscope ◽  
Nasotracheal Intubation ◽  
Line Of Sight ◽  
Intubation Time ◽  
Analog Scale ◽  
Magill Forceps ◽  
The Mean ◽  
Time Required ◽  
Non Line Of Sight

Abstract The Airtraq laryngoscope is a new intubation device that provides a non–line-of-sight view of the glottis. We evaluated this device by comparing the ease of nasotracheal intubation on a manikin with the use of Airtraq versus the Macintosh laryngoscope with and without Magill forceps. Nasotracheal intubation on a manikin was performed by 20 anesthesiologists and 20 residents with the Airtraq or Macintosh laryngoscope. The mean (± SD) time required for nasotracheal intubation by the residents was significantly shorter with the Airtraq laryngoscope than with the Macintosh laryngoscope (16 ± 7 sec vs 22 ± 10 sec; P < .001), but no difference in intubation time was observed between Airtraq (15 ± 11 sec) and Macintosh (13 ± 6 sec) laryngoscopy by the anesthesiologists. The Magill forceps was used more frequently to facilitate intubation with the Macintosh laryngoscope than with the Airtraq laryngoscope in both groups of operators 7(P < .001). The Airtraq laryngoscope scored better on the visual analog scale than did the Macintosh laryngoscope in both groups of operators (P < .05). The Airtraq laryngoscope offers potential advantages over standard direct laryngoscopy for nasotracheal intubation.

scholarly journals Effectiveness and safety of cuff inflation technique over conventional method of Magill forceps for Nasotracheal intubation under direct laryngoscopy: Randomized controlled trial

2021 ◽  
Vol 8 (4) ◽  
pp. 574-578
Author(s):  
Ami Bhayani ◽  
Apeksha Patwa
Keyword(s):  
Endotracheal Tube ◽  
Conventional Method ◽  
Direct Laryngoscopy ◽  
Nasotracheal Intubation ◽  
T Test ◽  
Cuff Inflation ◽  
Hemodynamic Parameters ◽  
Magill Forceps ◽  
Intergroup Comparison ◽  
Time Required

The aim of the study is to compare the effectiveness and safety of cuff inflation technique over conventional method of Magill forceps for Nasotracheal intubation NTI under direct laryngoscopy.After taking permission from institutional ethical committee, patients of 18-60 years of either sex of ASA grade I and ll were divided into groups of 40 each. In group C, cuff inflation technique and in group M, Magill forceps technique was used for navigating the endotracheal tube from oropharynx to glottic opening to achieve intubation. Parameters observed were time required for intubation, attempts of intubation, injury occurring to oropharyngeal structures during intubation and hemodynamic parameters. Cuff of endotracheal tube was assessed postoperatively for any leaksAnalysis of the data for the various parameters was done using paired t-test for intra-group comparison and student t-test for intergroup comparison and chi-square test was used for qualitative (non parametric) data.There was no significant difference in demographic parameters, time required for intubation, number of attempts for intubation and hemodynamic parameters, but trauma to oropharyngeal structures was more in group M (8/40) compared to group C (0/40). (p≤0.05) Trauma to cuff of endotracheal tube was seen in group M (1/40) while none in group C (0/40) which was statistically not significant (p≤0.05).Thus, Cuff inflation technique can be used as an effective alternative to Magill forceps for oropharyngeal navigation of endotracheal tube under direct laryngoscopy guided nasotracheal intubation in patients with normal airways.

Activity of Plasmin and Streptokinase-Activator on Substituted Arginine and Lysine Esters

1966 ◽  
Vol 16 (01/02) ◽  
pp. 018-031 ◽  
Author(s):  
S Sherry ◽  
Norma Alkjaersig ◽  
A. P Fletcher
Keyword(s):  
Molecular Structure ◽  
Methyl Ester ◽  
Comparative Studies ◽  
Esterase Activity ◽  
Methyl Esters ◽  
Hydrolytic Activity ◽  
The Other ◽  
Other Hand

SummaryComparative studies have been made of the esterase activity of plasmin and the streptokinase-activator of plasminogen on a variety of substituted arginine and lysine esters. Human plasmin preparations derived by different methods of activation (spontaneous in glycerol, trypsin, streptokinase (SK) and urokinase) are similar in their esterase activity; this suggests that the molecular structure required for such esterase activity is similar for all of these human plasmins. Bovine plasmin, on the other hand, differs from human plasmin in its activity on several of the substrates studied (e.g., the methyl esters of benzoyl arginine and tosyl, acetyl and carbobenzoxy lysine), a finding which supports the view that molecular differences exist between the two animal plasmins. The streptokinase-activator hydrolyzes both arginine and lysine esters but the ratios of hydrolytic activity are distinct from those of plasmin and of other activators of plasminogen. The use of benzoyl arginine methyl ester as a substrate for the measurement of the esterase activity of the streptokinase-activator is described.

Constructing Prophetic Divination

2017 ◽  
Author(s):  
Martti Nissinen
Keyword(s):  
Comparative Studies ◽  
Theoretical Foundation ◽  
Eastern Mediterranean ◽  
Source Material ◽  
The Other ◽  
Near Eastern ◽  
Common Category ◽  
Divine Knowledge ◽  
Historical Phenomenon

This chapter lays the theoretical foundation of the book, defining prophecy as a non-technical, or inspired, form of divination, in which the prophet acts as an intermediary of divine knowledge. It is argued that prophecy is as much a scholarly construct as a historical phenomenon documented in Near Eastern, biblical, as well as Greek textual sources. The knowledge of the historical phenomenon depends essentially on the genre and purpose of the source material which, however, is very fragmentary and, due to its secondary nature, does not yield a full and balanced picture of ancient prophecy. The chapter also discusses the purpose of comparative studies, arguing that they are necessary, not primarily to reveal the influence of one source on the other, but to identify a common category of ancient Eastern Mediterranean prophecy.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

Mandibular Advancement Improves the Laryngeal View during Direct Laryngoscopy Performed by Inexperienced Physicians

2004 ◽  
Vol 100 (3) ◽  
pp. 598-601 ◽  
Author(s):  
Miki Tamura ◽  
Teruhiko Ishikawa ◽  
Rie Kato ◽  
Shiroh Isono ◽  
Takashi Nishino
Keyword(s):  
Direct Laryngoscopy ◽  
Statistical Difference ◽  
Elective Surgery ◽  
Muscle Relaxation ◽  
Mandibular Advancement ◽  
Friedman Test ◽  
Rating Score ◽  
Laryngeal View ◽  
Statistical Comparison ◽  
The Third

Background When oral or nasal fiberoptic laryngoscopy is attempted, mandibular advancement has been reported to improve the laryngeal view. The authors hypothesized that mandibular advancement may also improve the laryngeal view during direct laryngoscopy. Methods Forty patients undergoing elective surgery under general anesthesia were included in this study. After establishment of an adequate level of anesthesia and muscle relaxation, direct laryngoscopy was performed by inexperienced physicians. Four different maneuvers--simple direct laryngoscopy without any assistance (C), simple direct laryngoscopy with mandibular advancement (M), simple direct laryngoscopy with the BURP maneuver (backward, upward, rightward pressure maneuver of the larynx; B), and simple direct laryngoscopy with both mandibular advancement and the BURP maneuver (BM)--were attempted in each subject, and the laryngeal aperture was videotaped with each procedure. An instructor in anesthesiology who was blinded to the procedure evaluated the visualization by reviewing videotape off-line, using the Cormack-Lehane classification system (grades I-IV) and a rating score within each subject (1 = best view; 4 = poorest view). The Friedman test followed by the Student-Newman-Keuls test was performed for statistical comparison. P < 0.05 was considered significant. Results The laryngeal view was improved with M and B when compared with C (P < 0.05 by both rating and Cormack-Lehane evaluation). BM was the most effective method to visualize the laryngeal aperture (P < 0.05, vs. B and M by rating evaluation), whereas B and M were the second and the third most effective methods, respectively. No statistical difference was observed between B and M with the Cormack-Lehane classification. Conclusion Mandibular advancement improves the laryngeal view during direct laryngoscopy performed by inexperienced physicians.

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