Use of a 90‐degree anticlockwise tube rotation to facilitate nasotracheal tube passage over the fiberscope into the trachea in pediatric patients

Xue, Fu Shan; Liu, Gao P.; Sun, Chao

doi:10.1111/pan.12885

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…Therefore, these factors could facilitate the advancement of the ETT above the glottis. [15] Our study had some limitation. Fiberoptic intubation can be di cult and requires operator skill, and the consequences of failure are signi cant.…”

Section: Discussionmentioning

confidence: 88%

“…The gap between the tip of the ETT and the beroptic scope can be reduced using a thicker beroptic scope and a thinner ETT. [13][14][15] Simultaneous rotation of the beroptic scope and ETT could lead to successful intubation by reducing impingement on the ETT. [8, 10, 14-17] However, the effect of various rotational angles on the beroptic scope and ETT is not supported by any evidence due to resistance to the passage of the ETT in the nasal cavity.…”

Section: Introductionmentioning

confidence: 99%

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The difference in rotation angle of the distal endotracheal tube through nasal approach

Tsukamoto

Goto

Hitosugi

et al. 2023

Preprint

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Background Nasal intubation using a fiberoptic scope is a useful technique. In clinical practice, we have experienced difficulty in advancing the endotracheal tube (ETT) over the fiberoptic scope because of resistance to the passage of the ETT against rotation in the nasal cavity, when it gets hung up on structures of the laryngeal inlet. Several maneuvers have been proposed to overcome this difficulty. The gap between the tip of the ETT and the fiberoptic scope can be reduced using a thicker fiberoptic scope and a thinner ETT. Moreover, simultaneous rotation of the fiberoptic scope and ETT could lead to successful intubation by reducing impingement on the ETT. However, the discrepancy between these rotation angles is unclear. This observational prospective study aimed to investigate the discrepancy in the rotation angle between the ETT and fiberoptic scope during nasal intubation.Methods The patients (aged 20–80 years) who underwent nasal intubation for oral and maxillofacial surgery participated in three sizes of preformed nasal ETT and were intubated using a fiberoptic scope. They were divided into three groups; the ETT internal diameter (ID) 6.5 mm (6.5 group), ID 7.0 mm (7.0 group), and ID 7.5 mm (7.5 group). The ETT was then inserted through the nasal cavity into the pharynx. After the fiberoptic scope was advanced through the ETT above the glottis, simultaneous rotation by both the proximal end of the fiberoptic scope and ETT was performed in 90° and 180° in both right (clockwise) and left (counterclockwise) directions, and the rotation angle at the distal end of the ETT was monitored using a video laryngoscope (Pentax-AWS).Results A total of 39 patients were included in the study. When both the proximal end of the fiberscope and ETT were simultaneously rotated by 90°, in the 6.5 group (n = 13), the distal end of the ETT rotated by 47.8 ± 1.5°. In the 7.0 °group (n = 13), the distal end of the ETT rotated by 45.5 ± 1.0°. In the 7.5 group (n = 13), the distal end of the ETT rotated by 39.9 ± 1.0°. When the proximal end of the fiberscope and ETT were rotated by 180°, in the 6.5 group, the distal end of the ETT rotated by 166.2 ± 2.5°. In the 7.0 group, the distal end of the ETT rotated by 145.7 ± 2.2°. In the 7.5 group, the distal end of the ETT rotated by 115.1 ± 2.0°. All rotation angles in the distal end of the ETT were significantly lower than those in both the proximal end of the fiberscope and ETT (p < 0.05). Rotating right by 180° was significantly different among the three groups (p < 0.05), although rotating right by 90° was not significantly different. Similar results were obtained for the left rotation.Conclusion Simultaneous rotation by the proximal end of the ETT and fiberscope during nasal intubation induced significant differences in the distal end of the ETT. The gap between the fiberoptic scope and ETT was wider, although ETT encountered more resistance.Trial registration This prospective observational study was conducted after receiving approval from the Ethics Review Board of Kyushu University Hospital (Approval No. 30–447).

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The difference in rotation angle of the distal endotracheal tube through nasal approach

Tsukamoto

Goto

Hitosugi

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…This is a rule for all types of VLs [8]. As with the previous trials, we needed to use a stylet [4], reinsertion and withdrawal of the blade [28], and a 90° anticlockwise rotation of the tube maneuvers [29] to increase the intubation success rate. Use of a stylet and applying the drawback (slight removal of the device to the mouth) maneuver was helpful for an endotracheal tube that had fallen posteriorly.…”

Section: Discussionmentioning

confidence: 99%

“…We based our sample size according to Yumul et al [12]. They used the McGrath MAC in morbidly obese patients and they found the total intubation time to be 62 ± 31 s. Lee et al [13] used the McGrath MAC in normal patients and found the total intubation time of nonobese patients to be 32 (27)(28)(29)(30)(31)(32)(33)(34)(35) s. Based on this data, for a = 0.05 and b = 0.2 we calculated our sample size as 40 patients in each group. Continuous data were examined for normal distribution with the Kolmogorov-Smirnov test.…”

Section: Total Orotracheal Intubation Timementioning

confidence: 99%

Tracheal intubation with the McGrath MAC X-blade videolaryngoscope in morbidly obese and nonobese patients

Arslan¹,

Yörükoğlu²

2019

Turk J Med Sci

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Background/aim: Increased body mass index (BMI) and neck circumference are the two independent predictors of difficult intubation. McGrath MAC X-Blade is a videolaryngoscope specifically designed for difficult intubations. Materials and methods: Eighty patients with the American Society of Anesthesiologists (ASA) physical status I-III undergoing elective surgery requiring endotracheal intubation were enrolled in the study. Patients were divided into two groups, nonobese (BMI < 30) and morbidly obese (BMI > 35). All patients were intubated with the McGrath MAC X-Blade in both groups. View optimization and tube insertion maneuvers such as reinsertion of the device, slight removal of the device, cricoid pressure, handling force, 90° anticlockwise rotation of the tube, use of stylet, and head flexion maneuvers were recorded. Cormack-Lehane grades, insertion times, intubation, and total intubation times were recorded. The hemodynamic changes and postoperative minor complications were also recorded. Results: Body mass index, neck circumference, Mallampati scores, and ASA physical status were statistically higher in the morbidly obese group (P < 0.001 and P < 0.05). Sternomental distances were shorter in the morbidly obese (P < 0.05). Cormack-Lehane grades were comparable among the groups. The morbidly obese patients required more reinsertion attempts and cricoid pressure maneuvers during intubation than the nonobese patients (P = 0.019 versus P = 0.012, respectively). Slight removal of the device, handling force, use of the stylet, 90° anticlockwise rotation of the tube, and head flexion maneuvers were also helpful in both groups. Although device insertion times were similar between the groups, intubation and total intubation times were longer in the morbidly obese group (P = 0.009 and P = 0.034, respectively). The groups were comparable in hemodynamic changes and postoperative minor complications. Conclusion: The McGrath MAC X-Blade videolaryngoscope could safely be used both in nonobese (BMI < 30) and morbidly obese (BMI > 35) patients with the aid of some key maneuvers and with a statistically significant but clinically negligible prolongation of the intubation time.

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The difference in rotation angle of the distal endotracheal tube through nasal approach

et al. 2023

View full text Add to dashboard Cite

Background Nasal intubation using a fiberoptic scope is a useful technique. In clinical practice, we have experienced difficulty in advancing the endotracheal tube (ETT) over the fiberoptic scope because of resistance to the passage of the ETT against rotation in the nasal cavity, when it gets hung up on structures of the laryngeal inlet. Several maneuvers have been proposed to overcome this difficulty. The gap between the tip of the ETT and the fiberoptic scope can be reduced using a thicker fiberoptic scope and a thinner ETT. Moreover, simultaneous rotation of the fiberoptic scope and ETT could lead to successful intubation by reducing impingement on the ETT. However, the discrepancy between these rotation angles is unclear. This observational prospective study aimed to investigate the discrepancy in the rotation angle between the ETT and fiberoptic scope during nasal intubation. Methods The patients (aged 20–80 years) who underwent nasal intubation for oral and maxillofacial surgery participated in three sizes of preformed nasal ETT and were intubated using a fiberoptic scope. They were divided into three groups; the ETT internal diameter (ID) 6.5 mm (6.5 group), ID 7.0 mm (7.0 group), and ID 7.5 mm (7.5 group). The ETT was then inserted through the nasal cavity into the pharynx. After the fiberoptic scope was advanced through the ETT above the glottis, simultaneous rotation by both the proximal end of the fiberoptic scope and ETT was performed in 90° and 180° in both right (clockwise) and left (counterclockwise) directions, and the rotation angle at the distal end of the ETT was monitored using a video laryngoscope (Pentax-AWS). Results A total of 39 patients were included in the study. When both the proximal end of the fiberscope and ETT were simultaneously rotated by 90°, in the 6.5 group (n = 13), the distal end of the ETT rotated by 47.8 ± 1.5°. In the 7.0 °group (n = 13), the distal end of the ETT rotated by 45.5 ± 1.0°. In the 7.5 group (n = 13), the distal end of the ETT rotated by 39.9 ± 1.0°. When the proximal end of the fiberscope and ETT were rotated by 180°, in the 6.5 group, the distal end of the ETT rotated by 166.2 ± 2.5°. In the 7.0 group, the distal end of the ETT rotated by 145.7 ± 2.2°. In the 7.5 group, the distal end of the ETT rotated by 115.1 ± 2.0°. All rotation angles in the distal end of the ETT were significantly lower than those in both the proximal end of the fiberscope and ETT (p < 0.05). Rotating right by 180° was significantly different among the three groups (p < 0.05), although rotating right by 90° was not significantly different. Similar results were obtained for the left rotation. Conclusion Simultaneous rotation by the proximal end of the ETT and fiberscope above the glottis for the nasal approach induced significant differences in the distal end of the ETT. The larger tube lagged by the resistance of the nasal passages during rotation. Therefore, the ETT does not rotate as much as the rotation angle. Trial registration This prospective observational study was conducted after receiving approval from the Ethics Review Board of Kyushu University Hospital (Approval No. 30–447).

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Use of a 90‐degree anticlockwise tube rotation to facilitate nasotracheal tube passage over the fiberscope into the trachea in pediatric patients

Cited by 3 publications

References 5 publications

The difference in rotation angle of the distal endotracheal tube through nasal approach

The difference in rotation angle of the distal endotracheal tube through nasal approach

Tracheal intubation with the McGrath MAC X-blade videolaryngoscope in morbidly obese and nonobese patients

The difference in rotation angle of the distal endotracheal tube through nasal approach

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