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 The Effects of Mouth Opening and Throat Pack Placement on Uncuffed Nasal Endotracheal Tube Leakage and Delivered Tidal Volumes in Mechanically Ventilated Pediatric Patients Undergoing Dental Procedures

2018 ◽  
Vol 65 (4) ◽  
pp. 237-243
Author(s):  
Katie E. Bradford ◽  
Louis I. Siegelman ◽  
Walter J. Psoter
Keyword(s):  
New York ◽  
Endotracheal Tube ◽  
Pediatric Patients ◽  
Medical Center ◽  
Mouth Opening ◽  
Nasal Intubation ◽  
New York University ◽  
Mechanically Ventilated ◽  
Dental Procedures ◽  
Throat Pack

Intubation for pediatric patients is frequently performed with an uncuffed endotracheal tube (ETT), which may result in an incomplete tracheal seal, resulting in gas leakage (leak). The purpose of this study was to assess the effect of (1) mouth opening and (2) throat pack placement in sealing and/or minimizing this leak to an acceptable level while providing adequate tidal volumes in mechanically ventilated patients. This prospective study of 2- to 6-year-olds undergoing general anesthesia with nasal intubation for dental procedures in the New York University–Lutheran Medical Center operating room was conducted between March 2015 and October 2015. Three sequential tidal volume (VT) measurements were recorded: postintubation with the neck extended, with mouth opened, and after throat pack placement. Twenty-five subjects were included in the analyses. For subjects in whom no leak was detected, only throat pack placement statistically improved VT. This is in marked contrast to numerically large, statistically significant effects, relative to baseline, for mouth opening (±23.2 mL, p < .009, 21% increase from baseline) and throat pack placement (±46 mL, p < .009, 41% increase from baseline) when a leak was detected. In children 2–6 years of age, nasal intubation with uncuffed ETTs that have incomplete tracheal seal have improved VT with mouth opening and throat pack placement. This finding suggests that the intubation procedure is a process that extends through positioning, mouth opening, and throat pack placement.

scholarly journals Application of Gum Elastic Bougie to Nasal Intubation

2010 ◽  
Vol 57 (3) ◽  
pp. 112-113 ◽  
Author(s):  
Hirofumi Arisaka ◽  
Shigeki Sakuraba ◽  
Munetaka Furuya ◽  
Kazutoshi Higuchi ◽  
Hitoshi Yui ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Tracheal Tube ◽  
Oral Surgery ◽  
Nasotracheal Intubation ◽  
Nasal Intubation ◽  
Difficult Airway Management ◽  
Dental Procedures ◽  
Difficult Airways

Abstract Gum elastic bougie (GEB), a useful device for difficult airway management, has seldom been used for nasotracheal intubation. Among 632 patients undergoing dental procedures or oral surgery, GEB was used successfully in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or maldirection of the tip of the tracheal tube. We recommend that GEB should be applied from the first attempt for nasal intubation in patients with difficult airways.

Comparison among the Intubation Techniques Employed in the Course of Management of Pan-Facial Trauma

2021 ◽  
Author(s):  
Aravindh RJ
Keyword(s):  
General Anesthesia ◽  
Nasotracheal Intubation ◽  
Functional Results ◽  
Orotracheal Intubation ◽  
Facial Trauma ◽  
Minimal Risk ◽  
Intermaxillary Fixation ◽  
Intubation Technique ◽  
Submental Intubation ◽  
Intraoperative Period

Objective: To find the best method of intubation in patients sustaining pan-facial trauma by comparing the pros and cons of each technique. Materials and methods: Three different types of intubation techniques (nasotracheal intubation, orotracheal intubation, and sub-mental intubation) were considered in this study. The study population involves 9 patients who have undergone treatment for pan-facial trauma under general anesthesia (3 patients per technique) and the variables of clinical outcome of each group were recorded. Results: Nasal intubation is the most common and safest method of intubation. However, it can’t be used in some types of pan-facial trauma. In cases like these, oral intubation is not preferred. As it severely compromises maxillofacial repair because of interference with the placement of intermaxillary fixation [3](IMF), which is used to establish the patient s occlusion in the intraoperative period. Submental intubation is an alternative with minimal risk to tracheostomy when orotracheal or nasotracheal intubation is not appropriate. The submental intubation technique gave an uninterrupted surgical field, unobstructed airway, ease of gaining occlusion in general anesthesia, less intraoperative and postoperative complications and it overcomes the disadvantages of both nasotracheal and orotracheal intubation. Conclusion: Preferred techniques of securing an airway are orotracheal, nasotracheal intubation. However these techniques may not always be applicable, thus a trauma surgeon-anesthetist team should always have alternative techniques in their armamentarium which secures the patient's airways without interfering with occlusion, to gain at most postoperative esthetic and functional results.

Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Thigh Muscle ◽  
Muscle Injuries ◽  
Invasive Approach ◽  
Novel Approach ◽  
Duration Of Surgery ◽  
Biomaterial Application ◽  
Split Skin

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pres

Computer Guided Surgery for Implant Placement and Dental Rehabilitation in a Patient Undergoing Sub-Total Mandibulectomy and Microvascular Free Flap Reconstruction

2013 ◽  
Vol 39 (4) ◽  
pp. 497-502 ◽  
Author(s):  
Andrew Dawood ◽  
Susan Tanner ◽  
Iain Hutchison
Keyword(s):  
Free Flap ◽  
Soft Tissues ◽  
Rapid Prototype ◽  
Life Questionnaire ◽  
Invasive Approach ◽  
Jaw Reconstruction ◽  
Post Surgery ◽  
Implant Placement ◽  
Mandibular Body ◽  
Microvascular Free Flap

A 58-year-old patient presented with an extensive, destructive, recurrent pleomorphic adenoma occupying the mandibular body and the soft tissues of the mouth and neck. Resection of the mandible from right ramus to left condylar process, and implant rehabilitation in both jaws with fixed bridgework was planned. Comprehensive presurgical prosthetic work up was carried out to record the existing dental relationship and guide all stages of the reconstruction. The jaw was first grafted with a segmented, fibular microvascular free-flap, which was fixed in place with a fixation plate prebent on a Rapid Prototype Anatomical Model of the jaw. Reconstruction with implant supported fixed partial dentures took place to the dental scheme planned preresection, using a computer guided approach to implant placement in the complex and unfamiliar anatomy of the extensively grafted mandible. This approach facilitated and expedited implant surgery such that treatment could take place using a minimally invasive approach relatively soon after surgery, prior to commencement of radiotherapy, and highlights the importance of a multidisciplinary approach to treatment for patients having extensive surgery to the jaws. The patient's personal assessment 2 years post surgery was recorded using 1999 University of Washington Quality of Life Questionnaire.

Department of Additional Information

1986 ◽  
Vol 7 (7) ◽  
pp. 222-222
Author(s):  
MARGARET A. KENNA
Keyword(s):  
Nasotracheal Intubation ◽  
Epstein Barr Virus Infection ◽  
Additional Information ◽  
Barr Virus ◽  
Nasopharyngeal Airway ◽  
Epstein Barr ◽  
Barr Virus Infection ◽  
The Many ◽  
Posterior Pharynx ◽  
Excellent Article

While reading the otherwise excellent article, "The Many Faces of Infectious Mononucleosis: The Spectrum of Epstein-Barr Virus Infection in Children" (Pediatrics in Review 1985;7:35-44), I noted that Dr Grose refers to the airway management of these children done at the Children's Hospital of Pittsburgh. Dr Snyderman's article to which Dr Grose refers (Pediatric Clinics of North America 1981;28:1011-1016), however, does not recommend nasotracheal intubation, as described by Dr Grose but, rather, placement of a nasopharyngeal airway. This tube does not enter the trachea between the vocal cords but, essentially, bypasses the enlarged adenoids and tonsils and rests in the posterior pharynx.

TRANSIENT BACTEREMIA DURING DENTAL MANIPULATION IN CHILDREN

PEDIATRICS ◽  
1973 ◽  
Vol 51 (3) ◽  
pp. 476-479
Author(s):  
Frederic A. Berry ◽  
Sandra Yarbrough ◽  
Nelson Yarbrough ◽  
Catherine M. Russell ◽  
Martha A. Carpenter ◽  
...  
Keyword(s):  
Heart Disease ◽  
General Anesthesia ◽  
Postoperative Period ◽  
Recovery Room ◽  
Pediatric Patients ◽  
Nasotracheal Intubation ◽  
Blood Cultures ◽  
Dental Abnormalities ◽  
Dental Procedures ◽  
Carious Teeth

Pediatric patients with moderate to severe dental abnormalities were screened for bacteremia during restoration and/or extraction of carious teeth under general anesthesia. Blood cultures were obtained before nasotracheal intubation, after intubation, after restoration of carious teeth but before extraction, following extraction of teeth, and in the immediate postoperative period. All cultures before intubation were negative in the 34 children studied. Twelve percent were positive after nasotracheal intubation (p < .05), 16% were positive after restoration of carious teeth (p < 0.025), 65% were positive after extraction of carious teeth (p < .0005), and 14% were positive in the recovery room (p < .025). Although the incidence of bacteremia in these pediatric patients was lower than the incidence reported in adults following dental procedures, the need for the prophylactic administration of antibiotics in children with heart disease who are to undergo dental manipulations is clear.

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.

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