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.

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.

scholarly journals Dual Bougie Technique for Nasotracheal Intubation

2012 ◽  
Vol 59 (2) ◽  
pp. 85-86 ◽  
Author(s):  
Rasjesh Mahajan ◽  
Parvaiz Ahmed ◽  
Firdose Shafi ◽  
Rishab Bassi
Keyword(s):  
Difficult Airway ◽  
Nasotracheal Intubation ◽  
Anesthetic Technique ◽  
Nasal Intubation ◽  
Recent Issue ◽  
Orotracheal Tube ◽  
Nasotracheal Tube

We read with great interest the anesthetic technique of using a gum elastic bougie (GEB) for nasal intubation in a recent issue of Anesthesia Progress. The authors recommend the use of GEB for the first attempt of nasotracheal intubation in patients with a difficult airway. We agree that this is an excellent alternative. We also have found an excellent variation of this method that utilizes a double bougie technique for insertion of a nasotracheal tube if the difficult airway can be secured initially with an orotracheal tube.

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.

scholarly journals Sudden Tachycardia Due to Submucosal Migration of an Epinephrine-Soaked Swab During Nasal Intubation

2018 ◽  
Vol 65 (4) ◽  
pp. 259-260 ◽  
Author(s):  
Tsuyoshi Hoshi ◽  
Takashi Suzuki ◽  
Masayuki Somei ◽  
Takehiko Iijima ◽  
Yuka Kurihara
Keyword(s):  
General Anesthesia ◽  
Nasal Cavity ◽  
Tracheal Tube ◽  
Sinus Tachycardia ◽  
Nasotracheal Intubation ◽  
Nasal Passage ◽  
Nasal Intubation ◽  
Third Molars ◽  
False Passage ◽  
Mandibular Third Molars

A 23-year-old healthy man was scheduled for extraction of his mandibular third molars under general anesthesia with nasotracheal intubation. Sudden sinus tachycardia up to 170 beats/min occurred when applying an epinephrine solution-soaked swab into the nasal cavity for preventing epistaxis during intubation. This was presumably evoked by submucosal migration of the swab into a false passage created because of the force applied during a prior failed attempt at nasal passage of the tracheal tube, and rapid epinephrine absorption by the traumatized mucosa. The causes of the unexpected severe tachycardia in our patient are discussed.

scholarly journals Reducing Nasopharyngeal Trauma: The Urethral Catheter–Assisted Nasotracheal Intubation Technique

2011 ◽  
Vol 58 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Allen Wong ◽  
Paul Subar ◽  
Heidi Witherell ◽  
Konstantin J Ovodov
Keyword(s):  
Soft Tissues ◽  
Nasotracheal Intubation ◽  
Mouth Opening ◽  
Urethral Catheter ◽  
Alternative Methods ◽  
Nasal Intubation ◽  
Intubation Technique ◽  
Invasive Approach ◽  
Dental Procedures ◽  
The Many

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.

scholarly journals Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial

2020 ◽  
Vol 9 (3) ◽  
pp. 671
Author(s):  
RyungA Kang ◽  
Ji Seon Jeong ◽  
Justin Sangwook Ko ◽  
Jaemyung Ahn ◽  
Mi Sook Gwak ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Head Position ◽  
Neutral Position ◽  
Dental Surgery ◽  
Intubation Difficulty ◽  
Difficulty Scale ◽  
Nasotracheal Tube ◽  
Glidescope Video Laryngoscope ◽  
Position Group

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

Paediatric tracheostomy

1987 ◽  
Vol 101 (9) ◽  
pp. 929-935 ◽  
Author(s):  
W. J. Newlands ◽  
W. S. McKerrow
Keyword(s):  
Airway Obstruction ◽  
Complication Rate ◽  
Acute Infection ◽  
Nasotracheal Intubation ◽  
Lower Airway ◽  
Artificial Airway ◽  
Long Duration ◽  
Nasotracheal Tube ◽  
Successful Employment ◽  
Lower Airway Obstruction

AbstractFifty-seven operations on 53 patients represents the total experience of tracheostomy in children under 13 years during 1964–1985 in an area with half a million inhabitants. No complications occurred during surgery and no deaths were related to the operations. Complications followed 16 out of 30 (53%) operations on children under three years and four out of 27 (15%) of the remainder, an overall complication rate of 35%. Many fewer operations have been required since 1973 because of the successful employment of nasotracheal intubation in the treatment of upper and lower airway obstruction caused by acute infection. Obstruction by-pass remains the commonest function of tracheostomy, with congenital lesions and trauma now the commonest causes of obstruction as opposed to acute infection in the earlier years. Despite the successful use of nasotracheal intubation there were absolute indications for tracheostomy—blockage of the nasotracheal tube; inability to intubate a child with epiglottitis; and necessity for an artificial airway of long duration.

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

scholarly journals Modified Retrograde Nasal Intubation: A New Airway Technique and Devices

2021 ◽  
Vol 68 (2) ◽  
pp. 107-113
Author(s):  
Vernon H. Vivian ◽  
Dip Anaes ◽  
Tyson L. Pardon ◽  
Andre A. J. Van Zundert
Keyword(s):  
Clinical Practice ◽  
Laryngeal Mask Airway ◽  
Nasotracheal Intubation ◽  
Maxillofacial Surgery ◽  
Oral Route ◽  
Oral And Maxillofacial Surgery ◽  
Nasal Intubation ◽  
Novel Technique ◽  
Materials Used ◽  
Airway Devices

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a “cannot intubate, cannot ventilate” scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices.

scholarly journals Repeated endotracheal tube cuff tears during nasotracheal intubation due to nasal cavity orthodontic micro-implant - A case report -

2021 ◽  
Author(s):  
Su Hyun Seo ◽  
Jun Mo Lee ◽  
Je Jin Lee ◽  
Eun Jin Ahn ◽  
Geun Joo Choi ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Endotracheal Tube ◽  
Orthognathic Surgery ◽  
Preoperative Evaluation ◽  
Nasotracheal Intubation ◽  
Air Bubbles ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Leakage Test ◽  
Micro Implants

Background: Nasotracheal intubation is generally performed for intraoral surgery.Case: A 34-year-old female patient who underwent orthognathic surgery exhibited repeated endotracheal tube cuff tears during nasotracheal intubation. After intubation, leaks developed, and torn endotracheal cuff was observed in the removed endotracheal tube. Subsequently, re-intubation through the same nasal cavity was performed immediately, but leakage from the torn endotracheal tube cuff was re-observed. A leakage test of the extubated tube revealed air bubbles and leaks near the tube cuff due to the tear. Nasotracheal intubation was performed through the other nasal cavity, and there were no leakage findings or abnormalities. During the course of the surgery, the surgeon noticed that the orthodontic micro-implant deposited in the mid-tube cavity was exposed to the nasal cavity. Conclusions: We aimed to emphasize caution and discuss the possibility that orthodontic micro-implants that are not confirmed during preoperative evaluation may cause repeated endotracheal tube cuff tears.

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