Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes

Ahmed-Nusrath, Anjum; Tong, Jianfeng; Smith, J. E.

doi:10.1093/bja/aem350

Cited by 67 publications

(62 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In nasotracheal intubation, the tracheal tube passes through either the upper or the lower pathway in the nasal cavity [1]. The upper pathway is a passage between the middle and inferior turbinates, whereas the lower pathway lies along the nasal floor, underneath the inferior turbinate (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Trauma to the middle turbinate may result in fracture, massive bleeding, cerebrospinal fluid rhinorrhea or olfactory nerve dysfunction [4,5], and the lower pathway may be a safer passage for tracheal tube placement. However, a nasal preformed tracheal tube, even when thermosoftened, has been reported to be more likely than a flexible reinforced tube to pass through the upper pathway [1].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

et al. 2014

View full text Add to dashboard Cite

SummaryDuring nasotracheal intubation, the tracheal tube passes through either the upper or lower pathway in the nasal cavity, and it has been reported to be safer that the tracheal tube passes though the lower pathway, just below the inferior turbinate. We evaluated the use of a nasogastric tube as a guide to facilitate tracheal tube passage through the lower pathway, compared with the ‘conventional’ technique (blind insertion of the tracheal tube into the nasal cavity). A total of 60 adult patients undergoing oral and maxillofacial surgery were included in the study. In 20 out of 30 patients (66.7%) with the nasogastric tube‐guided technique, the tracheal tube passed through the lower pathway, compared with 8 out of 30 patients (26.7%) with the ‘conventional’ technique (p = 0.004). Use of the nasogastric tube‐guided technique reduced the incidence and severity of epistaxis (p = 0.027), improved navigability (p = 0.034) and required fewer manipulations (p = 0.001) than the ‘conventional’ technique.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A flexible tip that has been incorporated in the manufacturing process of these endotracheal tubes offers a less traumatic alternative during nasal and oral endotracheal intubation. [23][24][25] Flexible-tip endotracheal tubes require some adaptation when conducting a nasal intubation technique, and might require some practice before the provider is fully proficient in utilizing them, but they can be useful tools in the effort to minimize airway-intubation trauma. More double-blind studies are needed to confirm their advantage over conventional endotracheal tubes.…”

Section: Flexible-tip Endotracheal Tubesmentioning

confidence: 99%

An overview of anesthetic procedures, tools, and techniques in ambulatory care

Messieha

2015

View full text Add to dashboard Cite

Ambulatory surgical and anesthesia care (ASAC), also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care.

show abstract

“…The literature describes many adjuncts that aim to decrease trauma and epistaxis such as nasopharyngeal airways, red rubber catheters, curved-tipped suction catheters, and inflated esophageal stethoscopes. Also described are variations in nasal intubation pathways 1 and evaluations of existing tube-tip designs.…”

Section: ^6mentioning

confidence: 99%

“…From this position it is ad-vanced toward the pharynx and slid along the floor of the nasal cavity and septal wall, guided carefully down the posterior pharynx through the laryngeal structures and into the trachea. 1,2 The most common complications of nasotracheal intubation include epistaxis, mucosal abrasion, and a sore throat of short duration. Other potential complications described in the literature include case reports of retropharyngeal perforation, traumatic tissue avulsion (eg, mucosal enlargements such as polyps or parts of turbinates), lacerations of nasal and pharyngeal structures, infections subsequent to mucosal trauma, glottic edema, tracheal stenosis, vocal cord palsy, and arytenoid cartilage dislocation.…”

mentioning

confidence: 99%

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

Prior

Heaton

Jatana

et al. 2010

Anesthesia Progress

View full text Add to dashboard Cite

The placement of endotracheal tubes in the airway, particularly through the nose, can cause trauma. Their design might be an important etiologic factor, but they have changed little since their introduction. Recently Parker Medical ( Bridgewater, Conn ) introduced the Parker Flex-Tip ( PFT ) tube, suggesting that it causes less trauma. This study aimed to compare the PFT endotracheal tube to a sidebeveled, standard-tip endotracheal tube ( ETT ) for nasotracheal intubation ( Figures 1 and 2). Forty consecutive oral surgery patients requiring nasotracheal intubation were randomized to receive either a standard ETT or the PFT tube. Intubations were recorded using a fiber-optic camera positioned proximal to the Murphy eye of the tube. This allowed visualization of the path and action of the tube tip as it traversed the nasal, pharyngeal, laryngeal, and tracheal airway regions. Video recordings made during intubation and extubation were evaluated for bleeding, trauma, and intubation time. Both bleeding and trauma were recorded using a visual analogue scale ( VAS ) and by 3 different evaluators. The PFT received significantly better VAS values than the standard tubes from all 3 raters (P , 0.05) in both the extent of trauma and bleeding. Since the intubations were purposefully conducted slowly for photographic reasons, neither tube displayed a time advantage. This study suggests that the PFT tube design may be safer by causing less trauma and bleeding than standard tube designs for nasotracheal intubation.

show abstract

Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes

Abstract: Endotracheal tubes, particularly preformed tubes, frequently take the less favourable pathway during nasotracheal intubation, in spite of specific attempts to avoid this.

Cited by 67 publications

References 11 publications

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

An overview of anesthetic procedures, tools, and techniques in ambulatory care

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

Contact Info

Product

Resources

About