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Lee J, Lee JM, Shim YH, Cho JG, Lee J, Lim JY, Chang CH. A randomized comparison of three intubation techniques/tube materials for nasotracheal intubation. Can J Anaesth 2024; 71:978-986. [PMID: 38548948 DOI: 10.1007/s12630-024-02743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE We sought to compare three intubation methods using different intubation techniques/tube materials for tube advancement from the nasal cavity into the oral cavity during nasotracheal intubation. METHODS We conducted a randomized clinical trial with adult patients scheduled to undergo elective surgery requiring nasotracheal intubation for general anesthesia. Participants were randomly allocated to a polyvinyl chloride (PVC) tube group (group P), PVC tube attached to a rubber catheter group (group PR), or velvet-soft PVC tube group (group V). Tracheal intubation was then performed based on group allocation. The primary outcome was the first-attempt success rate of tube advancement into the oral cavity; secondary outcomes included the time required for tube advancement into the oral cavity, total intubation time, and the incidence of epistaxis. RESULTS A total of 149 patients were included in the study. The first-attempt success rate in group V (90%) was significantly higher than that in group P (58%) (odds ratio, 6.5; 95% confidence interval [CI], 2.2 to 19.2), but similar to that in group PR (100%). The mean (standard deviation) time required for tube advancement into the oral cavity was significantly shorter in group V (16 [13] sec) than in group PR [40 (10) sec; 95% CI of mean difference, 17 to 30] and group P (26 [16] sec; 95% CI of mean difference, 3 to 16). Total intubation time was longest in group PR. Epistaxis occurred the least in group V. CONCLUSIONS Among the three intubation techniques/tube materials for nasotracheal intubation, the velvet-soft PVC tube provided the highest first-attempt success rate, most expeditious advancement into the oral cavity, and lowest incidence of epistaxis. STUDY REGISTRATION ClinicalTrials.gov (NCT04695444); first submitted 30 December 2020.
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Affiliation(s)
- Jiwon Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yon Hee Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Joung Goo Cho
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jimin Lee
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Chul Ho Chang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea.
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Kumar A, Gupta N, Bhargava T, Gupta A, Kumar V, Bharti SJ, Garg R, Mishra S, Bhatnagar S, Malhotra RK. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC ® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anaesth 2024; 71:503-510. [PMID: 38243098 DOI: 10.1007/s12630-023-02687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.
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Affiliation(s)
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
- Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India.
| | - Tanvi Bhargava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev K Malhotra
- Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India
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Statman BJ. Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 2. Anesth Prog 2023; 70:37-48. [PMID: 36995961 PMCID: PMC10069535 DOI: 10.2344/anpr-70-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 03/31/2023] Open
Abstract
Part 1 of "Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery" covered the physiological process of hemostasis and the pharmacology of both traditional and novel oral antiplatelets and anticoagulants. Part 2 of this review discusses various factors that are considered when developing a perioperative management plan for patients on oral antithrombotic therapy in consultation with dental professionals and managing physicians. Additionally included are how thrombotic and thromboembolic risks are assessed as well as how patient- and procedure-specific bleeding risks are evaluated. Special attention is given to the bleeding risks associated with procedures encountered when providing sedation and general anesthesia within the office-based dental environment.
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Kasaudhan S, Gupta M, Singh K, Khan A. A comparison of intubating conditions for nasotracheal intubation with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope employing cuff inflation technique in adult patients. Indian J Anaesth 2021; 65:S104-S109. [PMID: 34703054 PMCID: PMC8500197 DOI: 10.4103/ija.ija_236_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/28/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: While performing laryngoscopy during nasotracheal intubation (NTI), the tip of the advancing endotracheal tube (ETT) generally lies along the posterior pharyngeal wall. The inflation of the ETT cuff brings it anterior towards the glottis. The present study was planned to compare the intubating conditions for NTI with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope (VL) employing ETT cuff inflation technique. Methods: This prospective randomised study was carried out on 50 patients, American Society of Anesthesiologists physical status I–II, age 18–60 years of either sex with an indication for NTI under general anaesthesia. They were randomly divided into two groups: group VL (n = 25): C-MAC® VL and group ML (n = 25): Macintosh laryngoscope. The primary outcome was to compare the total duration of NTI (T), while the secondary outcomes were to compare the need for cuff inflation or assistance with Magill forceps for successful NTI, the total number of attempts to achieve successful NTI, haemodynamic effects and complications. Results: T was significantly higher in group ML than group VL (P < 0.001). The intubation was successful with cuff inflation in all the patients in group VL, however, six patients of group ML required assistance with Magill forceps (P = 0.022). The haemodynamic parameters were all significantly higher at 3 min in group ML in comparison to group VL. Conclusion: The cuff inflation technique when used along with C-MAC® VL had more success rate, required lesser time and had minimal postoperative complications in comparison to the Macintosh laryngoscope.
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Affiliation(s)
- Sonia Kasaudhan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Madhu Gupta
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Kriti Singh
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Anas Khan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
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Hu R, Niu JY, Wu LN, Sun H, Sun P, Huang JY, Yu JM. Comparison of a tube core and Magill forceps for nasotracheal intubation: a randomised controlled trial. Trials 2021; 22:697. [PMID: 34645510 PMCID: PMC8513329 DOI: 10.1186/s13063-021-05677-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/01/2021] [Indexed: 12/22/2022] Open
Abstract
Background Magill forceps are frequently used to complete nasotracheal intubation (NTI). We aimed to identify a tube core that could conveniently facilitate the NTI process without using Magill forceps. Methods Sixty patients scheduled for oral and maxillofacial surgeries were enrolled in our study and divided into two groups (30 per group) with no differences with regard to demographic data. In the Magill forceps group (Group M), a wire-reinforced endotracheal catheter was inserted into the trachea using Magill forceps. However, in the tube core group (Group T), a tube core bent to the physiological curve of the nasal cavity and lubricated with aseptic paraffin oil was inserted into the endotracheal catheter and was then withdrawn after the endotracheal catheter was advanced through the glottis under direct vision. Results All NTIs were completed successfully, and Magill forceps were not used on any patient in Group T. There was a significant difference in total NTI time between the two groups (Group M, 59.7 (5.1) s vs Group T, 52.4 (3.1) s). Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T (6/30 vs 5/30, respectively). No damage to oral tissue or teeth was observed in either group. Conclusions We conclude that using a tube core, consisting of a disposable sterilised stylet, is a convenient choice for NTI. Trial registration Patient enrolment was conducted after registration in the Chinese Clinical Trial Registry (www.Chictr.org.cn, ChiCTR190002 7387). This trial was prospectively registered on 11 November 2019.
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Affiliation(s)
- Rui Hu
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Jing-Yi Niu
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Li-Ning Wu
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Hao Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Peng Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Jia-Ying Huang
- Department of Otorhinolaryngology Surgery, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China
| | - Jun-Ma Yu
- Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China.
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Vivian VH, Anaes D, L Pardon T, Van Zundert AAJ. Modified Retrograde Nasal Intubation: A New Airway Technique and Devices. Anesth Prog 2021; 68:107-113. [PMID: 34185866 DOI: 10.2344/anpr-68-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/20/2021] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
| | - Dip Anaes
- General Practitioner-Anesthesiologist, Sunshine Coast, QLD, Australia
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Zhu WP, Fang X, Chooah O, Albaqali SM, Lin W. Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation. Surg Radiol Anat 2021; 43:1769-1776. [PMID: 34120193 DOI: 10.1007/s00276-021-02784-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the potential risk of the retropharyngeal internal carotid artery (RICA) during nasotracheal intubation (NTI). METHODS We retrospectively surveyed 2028 patients and 90 healthy controls (HC) with neck computed tomography angiography (CTA). The incidence of RICA was analyzed, as well as the correlation between the average minimum carotid-pharyngeal distance (CPD) and the carotid-median plane distance (CMD). We also compared CPD between RICA and HC. RESULTS RICA was observed in 91 out of the 2028 patients, reaching an incidence of 4.5% (91/2028). RICA in female patients was 65.9% (60/91) compared to 34.1% (31/91) in male patients. The incidence of RICA at nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) was 31.9% (29/91), 61.5% (56/91), and 6.6% (6/91), respectively. The incidence of the mucosal eminence of the posterior wall of the pharynx in RICA was 30.8% (28/91). In 15 cases, RICA caused the pharyngeal cavity to become narrow, with an incidence of 16.5% (15/91). Moreover, CPD and CMD was positively correlated (r = 0.56, p < 0.01). The average minimum CPD of RICA was only 2.25 ± 1.26 mm, which was much shorter than HC (17.62 ± 1.98 mm) (t = 62.46, p < 0.01). Some CPD of RICA was even less than 1 mm, with an incidence of 20.9% (19/91). CONCLUSION RICA is not uncommon in asymptomatic adults. It is very close to the midline and posterior wall of the pharynx and is more likely to occur in the nasopharynx (NP) and oropharynx (OP). RICA tear is likely to occur during NTI.
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Affiliation(s)
- Wan-Ping Zhu
- Post Anesthesia Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Hangzhou, 310016, China.
| | - Xiao Fang
- Anesthesiology Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Samar Mohamed Albaqali
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Lin
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Kim J, Pyeon T, Lee HJ, Yang HC. Maxillary sinusitis developed as sequelae of accidental middle turbinectomy that occurred during nasotracheal intubation: a case report. BMC Anesthesiol 2021; 21:126. [PMID: 33888091 PMCID: PMC8061043 DOI: 10.1186/s12871-021-01344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. However, little is known about the follow-up of patients after these complications. CASE PRESENTATION The present case describes an accidental middle turbinectomy that led to endotracheal tube obstruction during nasotracheal intubation, and discusses its long-term follow-up. A 19-year-old man underwent mandibular surgery under general anesthesia and nasotracheal intubation. His right middle turbinate was completely avulsed and became firmly occluded within the tube during nasotracheal intubation. The nasotracheal intubation was performed again and the operation was completed safely. The patient was discharged without sequelae after postoperative care. However, he had symptoms of nasal obstruction and sleep disturbance for 3 months postoperatively. Synechiae were detected between the nasal septum and lateral nasal wall on a right rhinoscopic examination and facial computed tomography at 3 months postoperatively. Additionally, he showed ipsilateral maxillary sinusitis on facial computed tomography at the 2-year follow-up examination. CONCLUSIONS Nasotracheal intubation can cause late complications as well as early complications. Therefore, if nasotracheal intubation is to be performed, the anesthesiologist should identify the nasal anatomy of the patient accurately and prepare appropriately. In addition, if complications occur, follow-up observation should be performed.
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Affiliation(s)
- Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 5 Hak-dong, Gwangju, 501-746, Republic of Korea
| | - Taehee Pyeon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 5 Hak-dong, Gwangju, 501-746, Republic of Korea
| | - Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Chonnam National University Hospital, 5 Hak-dong, Gwangju, 501-746, Republic of Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea.
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Rhee SH, Yun HJ, Kim J, Karm MH, Ryoo SH, Kim HJ, Seo KS. Risk factors affecting the difficulty of fiberoptic nasotracheal intubation. J Dent Anesth Pain Med 2020; 20:293-301. [PMID: 33195807 PMCID: PMC7644361 DOI: 10.17245/jdapm.2020.20.5.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022] Open
Abstract
Background The success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI). Methods FNI was performed by 18 anesthesiology residents under general anesthesia in patients over 15 years of age who underwent elective oral and maxillofacial operations. In all patients, the Mallampati grade was measured. Laryngeal view grade under direct laryngoscopy, and the degree of secretion and bleeding in the oral cavity was measured and divided into 3 grades. The time required for successful FNI was measured. If the intubation time was > 5 minutes, it was evaluated as a failure and the airway was managed by another method. The failure rate was evaluated using appropriate statistical method. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were also measured. Results A total of 650 patients were included in the study, and the failure rate of FNI was 4.5%. The patient's sex, age, height, weight, Mallampati, and laryngoscopic view grade did not affect the success rate of FNI (P > 0.05). BMI, the number of FNI performed by residents (P = 0.03), secretion (P < 0.001), and bleeding (P < 0.001) grades influenced the success rate. The AUCs of bleeding and secretion were 0.864 and 0.798, respectively, but the AUC of BMI, the number of FNI performed by residents, Mallampati, and laryngoscopic view grade were 0.527, 0.616, 0.614, and 0.544, respectively. Conclusion Unlike in intubation under direct laryngoscopy, in the case of FNI, oral secretion and nasal bleeding had a significant effect on FNI difficulty than Mallampati grade or Laryngeal view grade.
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Affiliation(s)
- Seung-Hyun Rhee
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hye Joo Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jieun Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Seung-Hwa Ryoo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
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Dhakate VR, Singam AP, Bharadwaj HS. Evaluation of Nasopharyngeal Airway to Facilitate Nasotracheal Intubation. Ann Maxillofac Surg 2020; 10:57-60. [PMID: 32855916 PMCID: PMC7433945 DOI: 10.4103/ams.ams_190_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/18/2019] [Accepted: 01/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Nasotracheal intubation is the most common method of airway management in oral and maxillofacial surgery patients. However, many times, it is associated with bleeding resulting from trauma to nasopharyngeal mucosa. We conducted this study to determine the effectiveness of nasopharyngeal airway (NPA) to easily facilitate the nasopharyngeal insertion and to reduce the trauma during nasotracheal intubation. Methods: A total of 120 patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly divided into two groups of 60 each, after preparation with xylometazoline drops intranasally, lubrication with lignocaine jelly, and thermosoftening of the tip of the endotracheal tube (ETT). In group NPA, dilatation of the nasal cavity was done with NPA before nasotracheal intubation and in Group C, nasotracheal intubation was done without dilatation of the nasal cavity. The smoothness of insertion of ETT was graded on a 4‑point rating scale. Assessment of bleeding into nasopharynx was confirmed during laryngoscopy and was also graded with 4‑point scale. Results: In the NPA group, all the 60 (100%) patients had smooth or relatively smooth (Grade 0 or 1) insertion compared to 51 (85%) patients in the control group (P < 0.0001). Eighteen (30%) patients had mild (Grade 1) bleeding and one (1.67%) patient had moderate bleeding (Grade 2) in the control group, whereas only four (6.67%) patients in the NPA group had mild (Grade 1) bleeding (P = 0.0005). Conclusion: Dilatation of nasal cavity with NPA significantly eases the insertion of ETT into the nasopharynx and also significantly decreases the incidence and severity of trauma and bleeding during nasotracheal intubation.
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Affiliation(s)
- Vinay R Dhakate
- Department of Anaesthesia, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Amol Prakash Singam
- Department of Anaesthesia, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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Seo KH, Kim KM, John H, Jun JH, Han M, Kim S. Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study. BMC Anesthesiol 2020; 20:114. [PMID: 32408862 PMCID: PMC7227116 DOI: 10.1186/s12871-020-01021-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immobilization with cervical spine worsens endotracheal intubation condition. Though various intubation devices have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning nasotracheal intubation (NTI) in patients with cervical spine immobilization. The present study compared the performance of the C-MAC D-Blade videolaryngoscope with the McCoy laryngoscope for NTI in patients with simulated cervical spine injuries. METHODS This was a prospective, randomized, controlled, study done in a tertiary hospital. Ninety-five patients requiring NTI were included in data analysis: McCoy group (group M, n = 47) or C-MAC D-Blade videolaryngoscope group (group C, n = 48). A Philadelphia neck collar was applied before anesthetic induction to immobilize the cervical spine. Single experienced anesthesiologist performed NTI. The primary outcome was duration of intubation divided by three steps: nose to oropharynx; oropharynx into glottic inlet; and glottic inlet to trachea. Secondary outcomes included glottic view as percentage of glottis opening (POGO) score and Cormack-Lehance (CL) grade, modified nasal intubation-difficulty scale (NIDS) rating, hemodynamic changes before and after intubation, and complications. RESULTS Total intubation duration was significantly shorter in group C (39.5 ± 11.4 s) compared to group M (48.1 ± 13.9 s). Group C required significantly less time for glottic visualization and endotracheal tube placement in the trachea. More patients in group C had CL grade I and higher POGO scores (P < 0.001, for both measures). No difficulty in NTI (modified NIDS = 0) was more in group C than group M. Hemodynamic changes and incidence of complications were comparable between groups. CONCLUSION The C-MAC D-Blade videolaryngoscope is an effective tool for NTI in a simulated difficult airway, which improves glottic visualization and shortens intubation time relative to those with McCoy laryngoscope. TRIAL REGISTRATION Clinical Research Information Service of the Korea National Institute of Health, Identification number: KCT 0004535, Registered December 10, 2019, Retrospectively registered, http://cris.nih.go.kr.
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Affiliation(s)
- Kwon Hui Seo
- Department of anesthesiology and pain medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dong-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Kyung Mi Kim
- Clinical assistant professor, Department of anesthesiology and pain medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Hyunji John
- Department of anesthesiology and pain medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dong-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Joo Hyun Jun
- Department of anesthesiology and pain medicine, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, 12, Siheung-daero 187-gil, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Minsoo Han
- Department of anesthesiology and pain medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dong-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Soyoun Kim
- Department of anesthesiology and pain medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dong-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
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12
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Kido K, Shindo Y, Miyashita H, Kusama M, Sugino S, Masaki E. Acute Management of Massive Epistaxis After Nasotracheal Extubation. Anesth Prog 2020; 66:211-217. [PMID: 31891291 DOI: 10.2344/anpr-66-02-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Epistaxis is one of the most common complications of nasotracheal intubation and can be life-threatening. However, there is little discussion in the current literature on the acute management of massive epistaxis after nasotracheal extubation. This is a report of 2 patients who experienced severe unanticipated nasal bleeding immediately after extubation, 1 after a surgical procedure for oral cancer and another after restorative dental treatment. In both cases the significant epistaxis was managed successfully with a Foley balloon catheter used to pack the posterior nasal cavity. The Foley catheter technique may be useful for managing and arresting sudden postextubation epistaxis.
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Affiliation(s)
- Kanta Kido
- Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Japan
| | - Yuki Shindo
- Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Japan
| | - Hitoshi Miyashita
- Department of Oral Medicine and Surgery, Division of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Mikio Kusama
- Department of Oral and Maxillofacial Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shigekazu Sugino
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Hospital, Sendai, Japan
| | - Eiji Masaki
- Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Japan
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13
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Sharma K, Ganapathy U, Gupta A, Bagga D. Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal Intubation in Anaesthetised Spontaneously Breathing Paediatric Patients. Turk J Anaesthesiol Reanim 2019; 49:37-43. [PMID: 33718904 PMCID: PMC7932718 DOI: 10.5152/tjar.2019.55453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Flexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route. Methods Sixty children aged 6–12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded. Results The time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting. Conclusion Intubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6–12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.
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Affiliation(s)
- Kirti Sharma
- Department of Anaesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India
| | - Usha Ganapathy
- Department of Anaesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Deepak Bagga
- Department of Paediatric Surgery, VMMC and Safdarjung Hospital, Delhi, India
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Takasugi Y, Futagawa K, Umeda T, Kazuhara K, Morishita S. Thermophysical Properties of Thermosoftening Nasotracheal Tubes. Anesth Prog 2019; 65:100-105. [PMID: 29952649 DOI: 10.2344/anpr-65-02-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Thermosoftening treatment of polyvinyl chloride (PVC) nasotracheal tubes (NTTs) can reduce the incidence and amount of epistaxis during nasotracheal intubation. The optimal thermal setting for thermosoftening treatment of NTTs without burn injury was investigated. Two composite types of PVC NTTs were used. Following withdrawal of the PVC NTTs from a bottle of water at 45 or 60°C, the changes in the surface temperature of the NTTs were measured by infrared thermography. Hardness of the NTTs at 25, 30, 35, and 40°C was measured. The incidence of epistaxis during nasotracheal intubation using thermosoftened NTTs was evaluated retrospectively. The surface temperature of both PVC NTTs dipped in 45 and 60°C water decreased to below body temperature 30 seconds after withdrawing them from the bottles. Although thermosoftening treatment proportionally decreased the hardness of both types of NTTs, the degrees differed according to their composition. When avoiding impingement of the NTT on the posterior wall of the nasopharynx, the incidence of mild and moderate epistaxis was 2.3%. Flexibility of PVC NTTs could be obtained by thermosoftening treatment at 60°C without burn injury. Thermosoftening treatment of PVC NTTs may be useful to avoid epistaxis during nasotracheal intubation.
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Affiliation(s)
- Yoshihiro Takasugi
- Assistant Professor, Department of Anesthesiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Koichi Futagawa
- Associate Professor, Department of Anesthesiology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan
| | - Takashi Umeda
- Professor, Graduate School of Health Sciences, Kansai University of Health Sciences, Osaka, Japan, and
| | - Kouhei Kazuhara
- Product Development Research Center, Daiken Medical Co Ltd, Osaka, Japan
| | - Satoshi Morishita
- Product Development Research Center, Daiken Medical Co Ltd, Osaka, Japan
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15
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A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation. Sci Rep 2018; 8:17365. [PMID: 30478457 PMCID: PMC6255773 DOI: 10.1038/s41598-018-35857-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/11/2018] [Indexed: 12/22/2022] Open
Abstract
We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3–39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0–43.0] s) and Pentax groups (43.0 [35.0–52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.
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16
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Özkan ASM, Akbas S, Toy E, Durmus M. North Polar Tube Reduces the Risk of Epistaxis during Nasotracheal Intubation: A prospective, Randomized Clinical Trial. Curr Ther Res Clin Exp 2018; 90:21-26. [PMID: 30787962 PMCID: PMC6369142 DOI: 10.1016/j.curtheres.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022] Open
Abstract
Objective In this study, a north polar tube (Portex® North Polar tube [Ivory PVC Portex tube; Smiths Medical International, Hythe, United Kingdom]) (NPT) and spiral tube (ST) were compared for their ability to provide a nasal airway in patients during maxillofacial surgery. Methods Patients who were aged 18 to 65 years with American Society of Anaesthesiologists score 1 to 2 and Mallampati score 1 to 2 were included in the study. The anesthesia technique was standardized in all patients. Patients were divided into 2 groups randomly: the NPT (n = 35) and ST groups (n = 35). Anesthesia was administered with 1% to 2% sevoflurane and a mixture of 50% oxygen + 50% air in both groups. The mean arterial pressure and heart rate values of preinduction; preintubation; and the first, second, third, and fifth minutes of intubation were recorded. Epistaxis, intraoral bleeding, cuff burst, use of Magill pens, duration of intubation, intubation difficulty, laryngeal compression, head position change, and glottic grade were evaluated. Results There were no significant differences between groups in terms of demographic data (gender, age, height, weight, body mass index, American Society of Anaesthesiologists score, and Mallampati score). Macintosh laryngoscopes were used during intubation in all patients. There was no significant difference between groups in terms of intubation difficulty, duration of intubation, use of Magill pens, and determination of the glottic grade (P > 0.05). Epistaxis was significantly lower in the NPT group than in the ST group (P = 0.012). Intraoral bleeding was significantly higher in the ST group than in the NPT group (P = 0.001). During intubation, laryngeal compression (Sellick maneuver) and head position changes were significantly lower in the NPT group than in the ST group (P = 0.003 and P < 0.001, respectively). There were no significant differences in mean arterial pressure and heart rate between the 2 groups. Conclusions We conclude that the NPT was associated with less epistaxis and manipulations such as laryngeal compression and head position changes when compared with the ST during nasotracheal intubation. The velvet-soft polyvinyl chloride material of the NPT appears to be responsible for this advantage.
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Affiliation(s)
- Ahmet Seli M Özkan
- Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sedat Akbas
- Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Erol Toy
- Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mahmut Durmus
- Department of Anesthesia and Reanimation, Faculty of Medicine, Inonu University, Malatya, Turkey
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17
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Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation. Anesthesiol Res Pract 2018; 2018:4910653. [PMID: 30154839 PMCID: PMC6092987 DOI: 10.1155/2018/4910653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient's own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation.
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Terumitsu M, Hirahara M, Seo K. Retropharyngeal Dissection by Parker Flex-Tip Nasal Endotracheal Tube. Anesth Prog 2018; 64:240-243. [PMID: 29200373 DOI: 10.2344/anpr-64-03-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Possible complications of nasotracheal intubation include injury to the nasal or pharyngeal mucosa. Dissection of the retropharyngeal tissue by the endotracheal tube is one of the rarer of the more severe complications. Previous studies have indicated that the Parker Flex-Tip (PFT) tracheal tube (Parker Medical, Highlands Ranch, Colo) reduces the incidence of mucosal injury. We experienced a case involving inadvertent retropharyngeal placement of a PFT tube in a 29-year-old patient during nasotracheal intubation under general anesthesia for elective dental treatment. Despite thermosoftening the PFT tube, expanding the nasal meatus, and ensuring gentle maneuvering, the tube intruded into the left retropharyngeal mucosa. However, the injury was not severe, and the only required treatment was the administration of antibiotics and corticosteroids. Even when a PFT tube is utilized, pharyngeal dissection is possible. When resistance is felt during passing of the PFT tube through the nasopharynx, an alternative method to overcome this resistance should be utilized.
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Affiliation(s)
- Makoto Terumitsu
- Associate Professor, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mikiko Hirahara
- Graduate Student, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenji Seo
- Professor, Division of Dental Anesthesiology, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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19
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Devarakonda BV, Issar Y, Goyal R, Vadapalli K. 'Where did the tube go?' A case of retropharyngeal submucosal false passage during nasal intubation. Med J Armed Forces India 2018; 75:476-478. [PMID: 31719746 DOI: 10.1016/j.mjafi.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/13/2018] [Indexed: 11/19/2022] Open
Abstract
Nasotracheal intubation could be associated with a variety of complications, of which traumatic complications are commonly encountered. We present a rare case of retropharyngeal submucosal false passage which occurred during nasotracheal intubation inspite of avoiding potential risk factors known for causing nasopharyngeal trauma. Risk factors, preventive measures and probable reason for this complication have been discussed.
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Affiliation(s)
| | - Yuvraj Issar
- Graded Specialist (Oral & Maxillofacial Surgery), HQ IMTRAT, C/O 99 APO, Bhutan
| | - Rakhee Goyal
- Professor (Anaesthesiology & Critical Care), Army Hospital (Research & Referral), New Delhi, India
| | - Kiranmai Vadapalli
- Assistant Professor (Physiology), Kamineni Institute of Medical Sciences, Narketpally, Telangana 508254, India
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20
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Song J. A comparison of the effects of epinephrine and xylometazoline in decreasing nasal bleeding during nasotracheal intubation. J Dent Anesth Pain Med 2017; 17:281-287. [PMID: 29349350 PMCID: PMC5766085 DOI: 10.17245/jdapm.2017.17.4.281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background Various techniques have been introduced to decrease complications during nasotracheal intubation. A common practice is to use nasal packing with a cotton stick and 0.01% epinephrine jelly. However, this procedure can be painful to patients and can damage the nasal mucosa. Xylometazoline spray can induce effective vasoconstriction of the nasal mucosa without direct nasal trauma. In this study, we aimed to compare the efficacy of these two methods. Methods Patients were randomly allocated into two groups (n = 40 each): xylometazoline spray group or epinephrine packing group. After the induction of general anesthesia, patients allocated to the xylometazoline spray group were treated with xylometazoline spray to induce nasal cavity mucosa vasoconstriction, and the epinephrine packing group was treated with nasal packing with two cotton sticks and 0.01% epinephrine jelly. The number of attempts to insert the endotracheal tube into the nasopharynx, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. An anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5 min after intubation and postoperative complications. Results No significant intergroup difference was observed in navigability (P = 0.465). The xylometazoline spray group showed significantly less epistaxis during intubation (P = 0.02). However, no differences were observed in epistaxis 5 min after intubation or postoperative epistaxis (P = 0.201). No inter-group differences were observed in complications related to nasal intubation and nasal pain. Conclusion Xylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.
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Affiliation(s)
- Jaegyok Song
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
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Yeom JH, Oh MK, Shin WJ, Ahn DW, Jeon WJ, Cho SY. Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps versus vascular forceps in patients with a normal airway. Can J Anaesth 2017; 64:1176-1181. [PMID: 28952139 PMCID: PMC5683062 DOI: 10.1007/s12630-017-0971-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/03/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The GlideScope® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL. METHODS This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups-i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO2 waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery. RESULTS The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8). CONCLUSION The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation. TRIAL REGISTRATION http://www.who.int/ictrp/network/cris2/en/ , CRIS, KCT0001310. Registered 29 July 2014.
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Affiliation(s)
- Jong H Yeom
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | - Mi K Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | - Woo J Shin
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | - Dae W Ahn
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | - Woo J Jeon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | - Sang Y Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-dong, Guri-si, Gyeonggi-do, 471-701, Republic of Korea.
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Futagawa K, Takasugi Y, Kobayashi T, Morishita S, Okuda T. Role of tube size and intranasal compression of the nasotracheal tube in respiratory pressure loss during nasotracheal intubation: a laboratory study. BMC Anesthesiol 2017; 17:141. [PMID: 29041911 PMCID: PMC5645985 DOI: 10.1186/s12871-017-0432-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/03/2017] [Indexed: 11/28/2022] Open
Abstract
Background Small nasotracheal tubes (NTTs) and intranasal compression of the NTT in the nasal cavity may contribute to increasing airway resistance. Since the effects of size, shape, and partial compression of the NTT on airway resistance have not been investigated, values of airway resistance with partial compression of preformed NTTs of various sizes were determined. Methods To determine the factors affecting the respiratory pressure loss during the nasotracheal intubation, physical and fluid dynamics simulations were used. The internal minor axes of NTTs in the nasal cavity of intubated patients were measured using dial calipers. In physical and fluid dynamics simulations, pressure losses through the tubular parts, compressed parts, and slip joints of NTTs with internal diameters (IDs) of 6.0, 6.5, 7.0, 7.5, and 8.0 mm were estimated under partial compression. Results The median internal minor axes of the 7.0- and 7.5-mm ID NTTs in the nasal cavity were 5.2 (4.3–5.6) mm and 6.0 (4.2–7.0) mm, respectively. With a volumetric air flow rate of 30 L/min, pressure losses through uncompressed NTTs with IDs of 6.0-, 6.5-, 7.0-, 7.5- and 8.0-mm were 651.6 ± 5.7 (6.64 ± 0.06), 453.4 ± 3.9 (4.62 ± 0.04), 336.5 ± 2.2 (3.43 ± 0.02), 225.2 ± 0.2 (2.30 ± 0.00), and 179.0 ± 1.1 Pa (1.82 ± 0.01 cmH2O), respectively; the pressure losses through the slip joints were 220.3 (2.25), 131.1 (1.33), 86.8 (0.88), 57.1 (0.58), and 36.1 Pa (0.37 cmH2O), respectively; and the pressure losses through the curvature of the NTT were 71.6 (0.73), 69.0 (0.70), 64.8 (0.66), 32.5 (0.33), and 41.6 Pa (0.42 cmH2O), respectively. A maximum compression force of 34.1 N increased the pressure losses by 82.0 (0.84), 38.0 (0.39), 23.5 (0.24), 16.6 (0.17), and 9.3 Pa (0.09 cmH2O), respectively. Conclusion Pressure losses through NTTs are in inverse proportion to the tubes’ IDs; greater pressure losses due to slip joints, acute bending, and partial compression of the NTT were obvious in small NTTs. Pressure losses through NTTs, especially in small NTTs, could increase the work of breathing to a greater extent than that through standard tubes; intranasal compression further increases the pressure loss.
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Affiliation(s)
- Koichi Futagawa
- Department of Anesthesiology, Nara Hospital, Kindai University Faculty of Medicine, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Yoshihiro Takasugi
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
| | - Takeharu Kobayashi
- Product Development Research Center, Daiken Medical Co. Ltd., 2-6-2, Ayumino, Izumi-city, Osaka, 594-1157, Japan
| | - Satoshi Morishita
- Product Development Research Center, Daiken Medical Co. Ltd., 2-6-2, Ayumino, Izumi-city, Osaka, 594-1157, Japan
| | - Takahiko Okuda
- Department of Anesthesiology, Nara Hospital, Kindai University Faculty of Medicine, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
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Oh JS, Choi HS, Kim EJ, Kim CH, Yoon JU, Yoon JY. Pharyngeal flap damage caused by nasotracheal intubation in a patient who underwent palatoplasty and pharyngoplasty. J Dent Anesth Pain Med 2017; 16:309-312. [PMID: 28879320 PMCID: PMC5564197 DOI: 10.17245/jdapm.2016.16.4.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022] Open
Abstract
Patients with cleft lip and palate (CLP) must undergo corrective surgeries during infancy and early childhood. Many patients with CLP undergo orthognathic surgery during their childhood for correction of skeletal asymmetries or pharyngoplasty with a pharyngeal flap to improve the quality of speech and velopharyngeal function. During orthognathic surgeries, nasotracheal intubation is performed under general anesthesia. In our case report, the patient had undergone palatoplasty and pharygoplasty previously. During the orthognathic surgery, a flexible fiberoptic bronchoscope-guided nasotracheal tube was inserted through the pharyngeal flap ostium; however, active bleeding occurred in the nasopharynx. Bleeding occurred because the flap was torn. After achieving hemostasis, the surgery was completed successfully. Thus, if a patient may show the potential for velopharyngeal port obstruction, nasotracheal intubation should be performed with utmost care.
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Affiliation(s)
- Jong-Shik Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Hong-Seok Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Young Yoon
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
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Talesh KT, Gargary RM, Arta SA, Yazdani J, Roshandel M, Ghanizadeh M, Kafil HS, Mousavi MNS. Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial. J Clin Diagn Res 2017; 11:PC08-PC12. [PMID: 28969192 DOI: 10.7860/jcdr/2017/29575.10396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea. AIM To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries. MATERIALS AND METHODS In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests. RESULTS In the mupirocin group, 27.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but no S. aureus was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but there was no change in the number of S. aureus counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001). CONCLUSION Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria.
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Affiliation(s)
- Kourosh Taheri Talesh
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Movassaghi Gargary
- Assistant Professor, Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ahmad Arta
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Yazdani
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Monireh Roshandel
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Ghanizadeh
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Assistant Professor, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mir Naser Seyyed Mousavi
- Assistant Professor, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Shohara K, Goto T, Kuwahara G, Isakari Y, Moriya T, Yamamuro T. Validity of rhinometry in measuring nasal patency for nasotracheal intubtion. J Anesth 2016; 31:1-4. [PMID: 27738802 DOI: 10.1007/s00540-016-2262-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 10/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Numerous techniques have been used to reduce epistaxis during nasotracheal intubation. Rhinometry can assess nasal patency in preoperative conditions. However, the possible role of rhinometry in routine nasotracheal intubation has not been studied. METHODS One hundred and one patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. We examined whether symmetry or any asymmetry in bilateral airflow patterns by condensation of the expiration, assessed by preoperative rhinometry on seated position, increased the incidence of epistaxis and the need for a nasogastric catheter to guide the endotracheal tube into the oropharynx. We also compared the incidence of changing the site of nasal intubation between the assessment by rhinometry and by cone-beam computed tomography analysis of nasal airspace in the inferior meatus. RESULTS Patients with any asymmetry in bilateral airflow patterns were 18 % (n = 18), the remaining 82 % (n = 83) had symmetric bilateral nasal cavities. Patients with any asymmetry were more likely to need a guiding nasogastric catheter than patients with symmetry (22 vs. 3.6 %, p = 0.018). The incidence of epistaxis was higher in patients with any asymmetry (39 %) than those with symmetry (16 %), but there was no significant difference between groups (p = 0.055). The site of intubation was changed more frequently based on cone-beam computed tomography analysis than by rhinometry (38 vs. 11 %, p = 0.043). CONCLUSION Preoperative rhinometry may be a valuable objective tool to assess nasal patency for nasotracheal intubation in patients who undergo dental and maxillofacial surgery.
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Affiliation(s)
- Ken Shohara
- Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan.
| | - Tomoko Goto
- Department of Anesthesiology, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan
| | - Goro Kuwahara
- Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan
| | - Yoshitoyo Isakari
- Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan
| | - Tomomi Moriya
- Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan
| | - Tukasa Yamamuro
- Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan
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Takasugi Y, Futagawa K, Konishi T, Morimoto D, Okuda T. Possible association between successful intubation via the right nostril and anatomical variations of the nasopharynx during nasotracheal intubation: a multiplanar imaging study. J Anesth 2016; 30:987-993. [PMID: 27678497 DOI: 10.1007/s00540-016-2253-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Most reported cases of nasopharyngeal laceration following impingement during nasotracheal intubation involved tube insertion via the right nostril. We postulated that recesses on the posterior wall of the nasopharynx might be associated with tube impingement. Using multiplanar imaging and clinical statistics, we evaluated whether anatomical variations in the recesses are related to successful intubation via the right nostril. METHODS Using multiplanar computed tomography (CT) images of 97 patients, we investigated the locations of recesses relative to the mid-sagittal plane, nasal floor plane and posterior end of the nasal septum, and their shapes. Incidents of impingement of the tube during nasotracheal intubation and the shapes of the fossa of Rosenmüller on CT images were retrospectively evaluated in 170 patients. RESULTS Eustachian tube orifices were located approximately 10 mm laterally from the sagittal plane, and approximately 10 mm above the nasal floor plane. The fossa of Rosenmüller was vertically elongated and located 7 mm laterally from the mid-sagittal plane. Pharyngeal bursae were found in 15 % of the subjects. Patients with failed insertion via the right nostril due to impingement frequently had a wide opening of the fossa of Rosenmüller. CONCLUSIONS Successful intubation via the right nostril is related to the anatomy of structures on the posterior nasopharyngeal wall, particularly recesses located close to the path of nasotracheal tube insertion. Nasopharyngeal anatomical variations should be considered when one notices any resistance to advancement of the tube into the nasopharynx during nasotracheal intubation.
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Affiliation(s)
- Yoshihiro Takasugi
- Department of Anesthesiology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
| | - Koichi Futagawa
- Department of Anesthesiology, Nara Hospital, Kindai University Faculty of Medicine, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
| | - Tatsuo Konishi
- Department of Radiology, Kindai University Hospital, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Daisuke Morimoto
- Department of Radiology, Kindai University Hospital, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Takahiko Okuda
- Department of Anesthesiology, Nara Hospital, Kindai University Faculty of Medicine, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan
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Al Shetawi AH, Golden L, Turner M. Anesthetic Complication during Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax. Craniomaxillofac Trauma Reconstr 2016; 9:251-4. [PMID: 27516842 DOI: 10.1055/s-0036-1572504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented.
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Affiliation(s)
- Al Haitham Al Shetawi
- Division of Oral & Maxillofacial Surgery, Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | - Leonard Golden
- Department of Anesthesiology, Jacobi Medical Center, Bronx, New York
| | - Michael Turner
- Division of Oral & Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York
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Kim DR, Jung YH, Kang H, Oh JI, Park YH. Accidental middle turbinectomy by nasotracheal intubation −A case report−. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.2.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dong Rim Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong Hun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-In Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Manabe Y, Iwamoto S, Seto M, Sugiyama K. Appropriate head position for nasotracheal intubation by using lightwand device (Trachlight). Anesth Prog 2014; 61:47-52. [PMID: 24932977 DOI: 10.2344/0003-3006-61.2.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of "unsuccessful" cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis.
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Affiliation(s)
- Yozo Manabe
- Department of Systemic Management for Dentistry, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
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Sanuki T, Kotani J. Thermosoftening of the Parker Flex-Tip(TM) tracheal tube in preparation for nasotracheal intubation. Anesth Prog 2013; 60:109-10. [PMID: 24010988 DOI: 10.2344/0003-3006-60.3.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Parker Flex-Tip tracheal tube (PFTT, Parker Medical, Highlands Ranch, Colo) has a soft, flexible, curved tip with double Murphy eyes. Previous studies have shown that the PFTT reduces the incidence of epistaxis during nasotracheal intubation and the incidence of postintubation nasal pain, as compared to conventional tracheal tubes. Although thermosoftening is a well-known and effective technique for reducing epistaxis during nasotracheal intubation with conventional tracheal tubes, we occasionally encounter difficulties with advancing the tube through the nasal passage when the PFTT is thermosoftened prior to nasotracheal intubation. Consequently, when using the PFTT for nasotracheal intubation, the procedure of thermosoftening should be avoided.
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Affiliation(s)
- Takuro Sanuki
- Assistant Professor, Department of Anesthesiology, Osaka Dental University, Osaka, Japan and Visting Professor, Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Angioedema is an underappreciated and potentially life-threatening complication of intravenous (IV) recombinant tissue plasminogen activator (rt-PA). Patients taking angiotensin converting enzyme (ACE) inhibitors are at increased risk of this rare complication. METHODS Case report. RESULTS A 74 year-old woman taking lisinopril for hypertension was treated with IV rt-PA for right hemispheric acute ischemic stroke. Shortly after completion of the rt-PA infusion, she developed asymmetric angioedema involving the tongue and left lower lip. No emergent airway intervention was needed. Following treatment with epinephrine, antihistamines, and corticosteroids, the edema resolved within 24 h. The patient made an excellent recovery from the ischemic stroke. CONCLUSIONS Orolingual angioedema can complicate rt-PA treatment of acute stroke and is often ipsilateral to the side of hemiparesis. Neurointensivists should be aware of this possibility, which is increased in patients taking ACE inhibitors. Epinephrine can be given safely in this scenario. Identification of high risk features may help guide decisions regarding early definitive airway management.
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Abstract
Among the potential risks of nasotracheal intubation are nasal bleeding, sinusitis, bacteremia, accidental turbinectomy, and some other structural damages. Retropharyngeal dissection is reported as a very rare complication of nasotracheal intubation, mostly encountered in elective surgery patients. A case with traumatic subcondylar fracture of the mandible is presented here, which is suspected to be the cause of the nasopharyngeal dissection that was observed during attempted nasotracheal intubation.
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Wong A, Subar P, Witherell H, Ovodov KJ. Reducing nasopharyngeal trauma: the urethral catheter-assisted nasotracheal intubation technique. Anesth Prog 2011; 58:26-30. [PMID: 21410362 DOI: 10.2344/0003-3006-58.1.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Allen Wong
- Department of Dental Practice, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California 94115, USA
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The success rate of nasotracheal intubation using lightwand does not depend on the laryngoscopic view. J Anesth 2011; 25:350-5. [DOI: 10.1007/s00540-011-1117-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
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Prior S, Heaton J, Jatana KR, Rashid RG. Parker flex-tip and standard-tip endotracheal tubes: a comparison during nasotracheal intubation. Anesth Prog 2010; 57:18-24. [PMID: 20331335 DOI: 10.2344/0003-3006-57.1.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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 side-beveled, 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.
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Affiliation(s)
- Simon Prior
- College of Dentistry, Division of Dental Anesthesiology, The Ohio State University, Columbus, Ohio 43210, USA.
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Ahmed-Nusrath A, Tong JL, Smith JE. Blood pressure and heart rate changes during intubation. Anaesthesia 2007; 62:95. [PMID: 17156248 DOI: 10.1111/j.1365-2044.2006.04922.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bonnin M, Therre P, Albuisson E, Beaujard H, Barthelemy I, Mondie JM, Bazin JE. Comparison of a propofol target-controlled infusion and inhalational sevoflurane for fibreoptic intubation under spontaneous ventilation. Acta Anaesthesiol Scand 2007; 51:54-9. [PMID: 17073850 DOI: 10.1111/j.1399-6576.2006.01186.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A propofol target-controlled infusion (TCI) is often proposed for the management of difficult airway intubation and fibreoptic intubation under anaesthesia and spontaneous ventilation. No data are available about sevoflurane. The aim of the present study was to compare propofol and sevoflurane as hypnotics during fibreoptic intubation under spontaneous ventilation. METHODS After regional ethical committee approval, 52 ASA I-II patients without any predictors for difficult intubation gave their informed consent. They were randomly assigned to one of two groups. After 3 min of pre-oxygenation, patients received either propofol with a plasmatic target concentration of 4 mg/l (group P; n= 26) or sevoflurane 4% with tidal volume ventilation (group S; n= 26). After 2 min, propofol was increased by 1 mg/l and sevoflurane was increased by 1% every 2 min until there was no reaction during mandible translation. This concentration was maintained for 4 min before starting nasotracheal fibrescopy for intubation. During both induction and fibrescopy, pulse oximetry, bispectral index (BIS), heart rate, and arterial blood pressure were monitored. Quality of intubation and operator satisfaction were evaluated. Data were compared using Student's t-test, Mann-Withney U-test or chi-square test. A P-value < 0.05% was considered to be significant. RESULTS During induction, no difference in pulse oximetry, BIS values at the end of induction, or duration of induction were noticed. Five episodes of desaturation under 90% occurred during fibreoptic intubation in group P compared with none in group S. CONCLUSION Sevoflurane provides good fibreoptic intubation conditions to spontaneously breathing patients without any hypoxemic episodes such as those observed with propofol.
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Affiliation(s)
- M Bonnin
- CHU Clermont-Ferrand, Services d'Anesthésie-Réanimation et de chirurgie maxillo-faciale, Hôtel-Dieu, Clermont-Ferrand, France et University Clermont1, Fac Médecine, Clermont-Ferrand, France
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Arora MK, Karamchandani K, Trikha A. Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases. Anaesthesia 2006; 61:291-4. [PMID: 16480357 DOI: 10.1111/j.1365-2044.2005.04516.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Management 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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Affiliation(s)
- M K Arora
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, 442, Hawa Singh block, Asiad games village, New Delhi-110049, India
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Delgado AV, Sanders JC. A simple technique to reduce epistaxis and nasopharyngeal trauma during nasotracheal intubation in a child with factor IX deficiency having dental restoration. Anesth Analg 2004; 99:1056-1057. [PMID: 15385350 DOI: 10.1213/01.ane.0000133914.26066.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epistaxis and airway trauma are often associated with nasotracheal intubation. We describe a patient with Factor IX deficiency who required nasotracheal intubation. An inexpensive, nonproprietary, rapid technique was used to reduce the trauma of intubation.
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Affiliation(s)
- Anita V Delgado
- Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque
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Abstract
Surgical procedures on structures of the oral cavity or the mandible may require nasotracheal intubation to allow for surgical access. Even with appropriate technique, trauma to the nasopharynx may occur, resulting in bleeding. The authors describe an alternative technique involving the placement of the flanged end of a red rubber catheter over the distal tip of the endotracheal tube (ETT) to decrease the potential for trauma as the ETT passes through the nasopharynx.
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Affiliation(s)
- Terry L Ray
- Department of Child Health, University of Missouri, Columbia, MO, USA
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