Nasotracheal Intubation: A Simple and Effective Technique to Reduce Nasopharyngeal Trauma and Tube Contamination

Enk, Dietmar; Palmes, Anne M.; Aken, Hugo Van; Westphal, Martin

doi:10.1097/00000539-200211000-00061

Cited by 51 publications

(40 citation statements)

References 10 publications

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“…Several mechanical aids have been used to facilitate blind nasotracheal intubation including suction catheters, nasogastric tubes, flexible lighted stylets, metallic stylets, nasopharyngeal airways and tracheal tubes [1][2][3][4][5][14][15][16][17][18]. Although the use of gum elastic bougie has been described as an aid in nasotracheal intubation, laryngoscopy has often been used to guide its advancement [19,20].…”

Section: Discussionmentioning

confidence: 99%

Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases

2006

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SummaryManagement of a difficult paediatric airway is challenging, and the unavailability of a paediatric fibreoptic bronchoscope, a common limitation in developing countries, adds to these difficulties. Children with bilateral temporomandibular joint ankylosis have limited mouth opening and therefore direct laryngoscopy and intubation is not usually possible. In the absence of sophisticated fibreoptic equipment, blind nasal intubation remains the only non-surgical option for control of the airway. Blind nasal intubation in paediatric anaesthesia is difficult. We describe a novel method of blind nasal intubation in paediatric patients using a gum elastic bougie. We have used this method successfully in three patients in whom tracheal intubation using a conventional blind nasal approach was unsuccessful. In view of its reliability and the absence of any soft tissue injury, we propose the use of this novel technique as an alternative to conventional blind nasal intubation, when more sophisticated fibreoptic equipment is not available.

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Section: Discussionmentioning

confidence: 99%

Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases

2006

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“…In addition, other traumatic events such as accidental middle turbinectomy have also been reported [12]. These complications make visualization of the trachea difficult and can potentially introduce blood and debris into the lungs, thereby becoming an airway emergency [7] [8] [11]- [17]. Avoidance of nasopharyngeal trauma in the airway is favored by surgeons and anesthesiologists, as laryngospasm and aspiration have significant repercussions [14].…”

Section: Summary Of the Literaturementioning

confidence: 99%

“…In two studies, authors describe a decreased incidence of pain reported by adult patients postoperatively following nasal intubation using a pathfinder technique for NTI [17] [18]. Future recommendations would be to conduct postoperative assessments in the pediatric population to correlate findings.…”

Section: Summary Of the Literaturementioning

confidence: 99%

“…Protecting the tip of the tube with a soft, flexible catheter prevents the contamination of mucous or tissue in the endotracheal tube from being transmitted into the trachea or bronchus. Enk, Palmes, Van Aken, and Westphal conducted a blinded randomized control trial using a pathfinder technique and found tube contamination with blood and mucous was remarkably decreased and significant by P < 0.001 [17]. Abrons,…”

Section: Summary Of the Literaturementioning

confidence: 99%

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A Safer Technique for Nasal Intubation: A Literature Review

Lera¹,

Machan²,

Derefaka³

2017

OJAnes

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Nasotracheal intubation (NTI) is the most widely used method to establish an airway during anesthesia for oral surgery. It has the advantage of providing exceptional accessibility and optimal working conditions in the oral cavity for surgeons. Anesthesia providers are highly trained in managing and securing the airway. Because the oral intubation route is the most widely used technique for securing the airway, nasal intubation can be cumbersome for anesthetists who do not routinely perform this skill. Moreover, anesthesia providers who do not routinely perform NTI may feel apprehension out of concern for nasopharyngeal bleeding and trauma. The number of dental and oromaxillofacial procedures requiring nasal intubation has been steadily growing annually. Although NTI is generally safe, it still presents a risk for complications. The purpose of this literature review was to examine current literature and evidence-based practices of NTI to determine whether the use of a catheter-guided technique will improve patient care outcomes by way of decreased trauma to the airway compared to current clinical practices. The goal of this review is to recommend the use of a catheter-guided technique for NTI as the preferred method for securing the airway during oral surgery as it is less traumatizing to the airway than conventional methods.

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“…It has been previously demonstrated that the shape of the tracheal tube tip is an important contributing factor to nasal mucosal trauma during nasotracheal intubation [3][4][5][6]. The Parker Flex-Tip TM tracheal tube (Parker Medical, Highlands Ranch, CO, USA) has a special tip, that is designed to glide past obstructions and pass easily through the glottis (Fig.…”

mentioning

confidence: 99%

The Parker Flex‐Tip™ tube for nasotracheal intubation: the influence on nasal mucosal trauma

et al. 2009

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SummaryWe tested our hypothesis that use of the Parker Flex‐Tip™ tracheal tube could reduce the incidence of nasal mucosal trauma during nasotracheal intubation when compared with a conventional tip tracheal tube. One hundred and two patients, who were scheduled for elective oral surgery in which nasotracheal intubation was indicated to optimise the surgical approach, were recruited into this study. Either a Flex‐Tip tracheal tube or a conventional tip tracheal tube was chosen randomly for each nasotracheal intubation. The incidence of epistaxis using the Flex‐Tip tracheal tube (6 (11.8%)) was significantly lower than that with the conventional tip tracheal tube (18 (35.3%); p = 0.009). Nasal pain due to intubation, rated on a 100‐mm visual analogue scale, was less intense with the Flex‐Tip tracheal tube (median, (10th–90th percentile) 19 (12–28) mm compared with the conventional tip tracheal tube (30 (22–35) mm; p < 0.001). The Flex‐Tip tracheal tube thus appeared to reduce the incidence of nasal mucosal trauma during nasotracheal intubation and the incidence of post‐intubation nasal pain, compared with the conventional tip tracheal tube.

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Nasotracheal Intubation: A Simple and Effective Technique to Reduce Nasopharyngeal Trauma and Tube Contamination

Cited by 51 publications

References 10 publications

Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases

Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases

A Safer Technique for Nasal Intubation: A Literature Review

The Parker Flex‐Tip™ tube for nasotracheal intubation: the influence on nasal mucosal trauma

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