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Dowsett PA, Khan SA, Khan AA, D'Souza RL, Reebye UN. An Alternative Airway Intervention to Preserve the Surgical Field in Oral and Maxillofacial Surgery. Surg Innov 2023; 30:529-532. [PMID: 36416642 DOI: 10.1177/15533506221141493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Background/need. Office-based sedation has become increasingly commonplace in dental offices in recent years, allowing for practitioners to provide broader scope of care for their patients. Maintaining high standards of safety is of utmost importance when sedation is utilized in the office-based setting, especially for patients deemed at a higher-risk for intraoperative airway obstruction. This demographic includes but is not limited to individuals with a medical history significant for obstructive sleep apnea, chronic obstructive pulmonary disease, and morbid obesity. Presently, a wide variety of airway devices exist for use in the event of airway obstruction. However, in the context of oral and maxillofacial surgery, placement of these devices can encroach upon the surgical field, extending the perioperative period and putting the patient at greater long-term risk for maintaining adequate oxygenation. Methodology. The authors describe a preliminary technique trialed in our offices which utilizes a size 5.0 endotracheal tube (5OET) as an adjunct supraglottic airway to help mitigate the issue of oxygen saturation maintenance, as well as unimpeded access to the oral cavity. Implementation of the device requires identifying appropriate candidates during preoperative screening and placing the device through the nare and securing it above the glottis. Device Description. The 'tube kit' is comprised of a standard size straight 5.0 cuffed oral ETT, a 5-mL syringe for inflation of the cuff post insertion, lubricant, flex extension tubing, end tidal sampling line for capnography, tape for securement of the 5OET, and an anesthesia breathing circuit. Optional equipment pieces include an elbow connecter and a foam piece for comfort. Results/Current Status. Preliminary results have demonstrated oxygen saturations maintained above 98% when the 5OET is placed preoperatively. Continued use of the trial device will inform the development of a tube by our clinicians, and its efficacy will be studied in our offices. The next steps will be to start developing a pilot cuff that will be submitted for patent approval after its use in IRB-approved clinical studies.
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Affiliation(s)
| | - Saad A Khan
- Creighton University School of Medicine, Omaha, NE, USA
| | - Amina A Khan
- Creighton University School of Medicine(Phoenix Regional Campus), Phoenix, AZ, USA
| | | | - Uday N Reebye
- Triangle Implant Center, Durham, NC, USA
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Duke Regional Hospital, Durham, NC, USA
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Sengel N, Toprak ME, Selmi NH, Atac MS. Using of panoramic and posteroanterior cephalometric radiographs to identify the optimal nasal passage for nasotracheal intubation. Niger J Clin Pract 2022; 25:647-652. [PMID: 35593608 DOI: 10.4103/njcp.njcp_1739_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aim Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. Materials and Methods The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Results There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. Conclusion The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.
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Affiliation(s)
- N Sengel
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
| | - M E Toprak
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
| | - N H Selmi
- Department of Anesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Onkoloji Eğitim ve Araştırma Hastanesi, Yenimahalle, Ankara, Turkey
| | - M S Atac
- Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey
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Tan YL, Wu ZH, Zhao BJ, Ni YH, Dong YC. For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:1180-1186. [PMID: 34617919 DOI: 10.1097/eja.0000000000001462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear. OBJECTIVE When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time. DATA SOURCES PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020. ELIGIBILITY CRITERIA The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia. RESULTS Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference -7.28 (-14.40 to -0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference -0.59 (-1.95 to 0.77) s, P = 0.40. CONCLUSION On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time. TRIAL REGISTRATION The study protocol has been registered in PROSPERO (CRD42020169949).
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Affiliation(s)
- Ying-Lun Tan
- From the Medical School of Nantong University, Nantong (YLT), Department of Oral Anesthesiology, Nanjing Stomatological Hospital (ZHW, BJZ, YCD) and Central Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China (YHN)
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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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Kim EM, Chung MH, Lee MH, Choi EM, Jun IJ, Yun TH, Ko YK, Kim JH, Jun JH. Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?: A Randomized Controlled Trial. Anesth Analg 2019; 129:812-818. [PMID: 31425224 DOI: 10.1213/ane.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT, irrespective of their stiffness, during direct laryngoscope-guided NTI. We evaluated whether thermosoftening of the ETT telescoped into rubber catheters has an additional benefit in reducing nasal injury. Simultaneously, we also evaluated whether thermosoftening of the ETT worsened orotracheal navigability during cuff inflation-supplemented videolaryngoscope-guided NTI. METHODS One hundred forty patients were randomly assigned to 1 of the 2 groups depending on whether the ETT was softened by warming or not. The primary outcome was the incidence of epistaxis during NTI. The secondary outcome was nasotracheal navigability of the ETT, assessed by navigation grade and time required for insertion of ETT in each phase (from nose to oropharynx, from oropharynx to glottic inlet aided by cuff inflation if needed, and from glottic inlet to trachea). RESULTS The ETTs were successfully inserted through the selected nostril of all 140 patients. In the thermosoftening group, the incidence and severity of epistaxis was significantly lower (7% vs 51%; difference of 44.2%; 95% confidence interval, 29.9%-56.2%; P < .001), and the ETT passed through the nasal cavity with lower resistance (P = .001) and less time (P < .001) when compared to the control group. No difference was found in the ease of ETT insertion (navigation grade and time required) from the oropharynx to the glottic inlet (P > .99 and P = .054, respectively) and from the glottic inlet to the trachea (P > .99 and P = .750, respectively) between the 2 groups. In both groups, all ETTs could be navigated into the trachea without the use of Magill forceps. CONCLUSIONS Supplemented with cuff inflation during videolaryngoscope-guided NTI, thermosoftening of the ETT telescoped into rubber catheters has a substantial benefit because it significantly reduces the incidence of epistaxis without worsening the oropharyngeal navigability of the ETT.
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Affiliation(s)
- Eun Mi Kim
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Mi Hwa Chung
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Mi Hyeon Lee
- Department of Anaesthesiology and Pain Medicine, Hongje Nara Pain Medicine, Seoul, Republic of Korea
| | - Eun Mi Choi
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - In-Jung Jun
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyung Yun
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yong Kuk Ko
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Joo Hyun Jun
- From the Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Lee B, Park WK, Yun SY, Kang S, Kim HJ. Insertion depth of nasotracheal tubes sized to fit the nostril: an observational study. J Int Med Res 2018; 47:235-243. [PMID: 30556457 PMCID: PMC6384463 DOI: 10.1177/0300060518800105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Nasotracheal (NT) intubation is commonly applied during head and neck surgery. However, improper tube size and depth may cause complications. In the current study, we investigated whether NT tubes are being appropriately used in terms of size and depth in adult patients. Methods Nares were sized in 40 patients using standard nasopharyngeal airways (6.0–8.0) before elective surgery under general anesthesia. The largest sized airway that passed easily into the nasopharynx without resistance was considered as a proper size. Using a fiberoptic scope, the distances from the nares to the vocal cords and the nares to the carina were measured. Rates of proper NT tube positioning were calculated with regard to the cuff and distal tip. Results The most frequent sizes of properly fitted NT tubes were 6.5 and 6.0 in male and female patients, respectively. Positioning of the cuff and distal tip was only appropriate when using a properly sized tube in 26% and 47% of male and female patients, respectively. Conclusion Care should be taken to determine the insertion depth after placing an NT tube that has been sized to fit the nostril. Moreover, NT tubes of the same diameter may be required in various lengths. Trial registration: Registered at ClinicalTrial.gov; https://clinicaltrials.gov/ct2/show/NCT02876913; Registration number NCT02876913
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Soon Young Yun
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Soojeong Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
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Kim H, Lee JM, Lee J, Hwang JY, Chang JE, No HJ, Won D, Choi S, Min SW. Influence of Nasal Tip Lifting on the Incidence of the Tracheal Tube Pathway Passing Through the Nostril During Nasotracheal Intubation. Anesth Analg 2018; 127:1421-1426. [DOI: 10.1213/ane.0000000000003673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Joshua J, Scholten E, Schaerer D, Mafee MF, Alexander TH, Crotty Alexander LE. Otolaryngology in Critical Care. Ann Am Thorac Soc 2018; 15:643-654. [PMID: 29565639 PMCID: PMC6207134 DOI: 10.1513/annalsats.201708-695fr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/22/2018] [Indexed: 01/02/2023] Open
Abstract
Diseases affecting the ear, nose, and throat are prevalent in intensive care settings and often require combined medical and surgical management. Upper airway occlusion can occur as a result of malignant tumor growth, allergic reactions, and bleeding events and may require close monitoring and interventions by intensivists, sometimes necessitating surgical management. With the increased prevalence of immunocompromised patients, aggressive infections of the head and neck likewise require prompt recognition and treatment. In addition, procedure-specific complications of major otolaryngologic procedures can be highly morbid, necessitating vigilant postoperative monitoring. For optimal outcomes, intensivists need a broad understanding of the pathophysiology and management of life-threatening otolaryngologic disease.
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Affiliation(s)
- Jisha Joshua
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Eric Scholten
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | | | - Mahmood F. Mafee
- Division of Neuroradiology, Department of Radiology, University of California–San Diego, San Diego, California
| | | | - Laura E. Crotty Alexander
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; and
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
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Takigawa M, Takahashi A, Kuwahara T, Okubo K, Nakashima E, Watari Y, Yamao K, Nakajima J, Tanaka Y, Takagi K, Kimura S, Hikita H, Hirao K, Isobe M. Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation. J Arrhythm 2017; 33:262-268. [PMID: 28765755 PMCID: PMC5529327 DOI: 10.1016/j.joa.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/11/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022] Open
Abstract
Background The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. Methods In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. Results At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P<0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% (P<0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P=0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding. Conclusion This unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective.
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Affiliation(s)
- Masateru Takigawa
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
- Heart Rhythm Centre, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Corresponding author at: Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan. Fax: +81 46 825 2103.Cardiovascular Centre, Yokosuka Kyosai Hospital1-16 Yonegahama-StreetYokosuka238-8558Japan
| | - Atsushi Takahashi
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Taishi Kuwahara
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kenji Okubo
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Emiko Nakashima
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Yuji Watari
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kazuya Yamao
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Jun Nakajima
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Yasuaki Tanaka
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Katsumasa Takagi
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Shigeki Kimura
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Hiroyuki Hikita
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kenzo Hirao
- Heart Rhythm Centre, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Boku A, Hanamoto H, Hirose Y, Kudo C, Morimoto Y, Sugimura M, Niwa H. Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial. J Clin Anesth 2014; 26:390-4. [DOI: 10.1016/j.jclinane.2014.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
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Comparison of 4% and 6% topical cocaine solutions for reduction of epistaxis induced by nasotracheal intubation. ACTA ACUST UNITED AC 2014; 52:17-21. [PMID: 24999214 DOI: 10.1016/j.aat.2014.05.001] [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: 11/11/2013] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasotracheal intubation (NTI) provides a good field for surgeons in patients undergoing oromaxillofacial surgery; however, NTI is often complicated by epistaxis. The aim of this study was to compare the efficacy of 4% and 6% topical cocaine solutions in reducing epistaxis during NTI. METHODS A total of 79 patients (16-65 years old) undergoing oromaxillofacial surgery were randomly assigned to two groups treated with either 4% cocaine (n = 39) or 6% cocaine (n = 40). Topical cocaine (1 mL) was sprayed onto the selected nasal cavity prior to NTI. All intubations were performed by an expert anesthesiologist using a GlideScope. The incidence and severity of epistaxis was examined along the nasal cavity up to the nasopharynx using a fiber optic bronchoscope. The hemodynamic responses to stimuli during the peri-NTI period were also recorded. RESULTS The incidence of epistaxis was 43.59% (17/39) in the 4% cocaine group and 50% (20/40) in the 6% cocaine group (p = 0.57). The severity of epistaxis did not differ between the two groups (p = 0.46). High resistance during NTI and epistaxis were closely correlated and the major bleeding sites were located at the nasopharynx. Compared with the 4% cocaine group, treatment with 6% cocaine resulted in a higher heart rate and mean arterial pressure (both p < 0.05). There was no statistically significance difference between the two groups with respect to the hemodynamic responses to NTI. CONCLUSION The spraying of either 4% or 6% topical cocaine into the nasal cavity gives comparable effects for intubation-related epistaxis. However, 6% cocaine may increase the hemodynamic responses while being sprayed. Therefore spraying with 4% topical cocaine had advantages with respect to 6% cocaine and is recommended for use prior to NTI.
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Lim CW, Min SW, Kim CS, Chang JE, Park JE, Hwang JY. The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial. Anaesthesia 2014; 69:591-7. [DOI: 10.1111/anae.12627] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C.-W. Lim
- Department of Anaesthesiology & Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - S.-W. Min
- Department of Anaesthesiology and Pain Medicine; SMG-SNU Boramae Medical Center; Seoul Korea
| | - C.-S. Kim
- Department of Anaesthesiology and Pain Medicine; SMG-SNU Boramae Medical Center; Seoul Korea
| | - J.-E. Chang
- Department of Anaesthesiology and Pain Medicine; SMG-SNU Boramae Medical Center; Seoul Korea
| | - J.-E. Park
- Department of Anaesthesiology & Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-Y. Hwang
- Department of Anaesthesiology and Pain Medicine; SMG-SNU Boramae Medical Center; Seoul Korea
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Sugiyama K, Manabe Y, Kohjitani A. A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: a randomized trial. Can J Anaesth 2014; 61:417-22. [DOI: 10.1007/s12630-014-0156-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 01/14/2014] [Indexed: 11/24/2022] Open
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Kumar R, Gupta E, Kumar S, Rani Sharma K, Rani Gupta N. Cuff Inflation-Supplemented Laryngoscope-Guided Nasal Intubation. Anesth Analg 2013; 116:619-24. [DOI: 10.1213/ane.0b013e31827e4d19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Kameyama K, Watanabe S, Kano T, Kusukawa J. Effects of Nasal Application of an Epinephrine and Lidocaine Mixture on the Hemodynamics and Nasal Mucosa in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2008; 66:2226-32. [DOI: 10.1016/j.joms.2008.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 11/12/2007] [Accepted: 01/04/2008] [Indexed: 10/21/2022]
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Case report: nasotracheal intubation--look before leaping to assess the laryngeal view. Can J Anaesth 2008; 55:302-5. [PMID: 18451119 DOI: 10.1007/bf03017208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To describe an airway management plan, including oral to nasal endotracheal tube exchange, when nasal intubation is required in the unanticipated difficult airway. CLINICAL FEATURES A nasal intubation was required for a patient undergoing oropharyngeal surgery. Following loss of consciousness and paralysis, a Cormack-Lehane class 3 view was obtained, and pressure over the thyroid cartilage failed to reveal the vocal cords. An Eschmann bougie was inserted into the oropharynx and blindly entered the trachea. An orotracheal tube was advanced into the trachea over the bougie, and the patient was ventilated with 100% O2 following the bougie's removal. An endotracheal tube was then guided through the right nostril into the hypopharynx. An Eschmann bougie was inserted into the nasal tube, and advanced towards the glottic opening under laryngoscopic view. Digital pressure applied to the oral tube at the base of the tongue brought the vocal cords into view. The oral endotracheal cuff was deflated, and the bougie (inserted into the nasal tube) was advanced into the trachea alongside the orotracheal tube. The orotracheal tube was withdrawn, and the nasal tube was advanced into the trachea over the bougie. The patient's O2 saturation and end-tidal CO2 concentration remained at 99-100% and 30-33 mmHg, respectively, during these maneuvers, which required only a few minutes to perform. CONCLUSION When nasotracheal intubation is required, a plan of airway management is required to safely secure the airway. We emphasize the importance of direct laryngoscopy prior to insertion of an endotracheal tube through the nose, and describe a strategy for oral to nasal tracheal tube exchange.
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Anesthetic implications of the new anticoagulant and antiplatelet drugs. J Clin Anesth 2008; 20:228-37. [DOI: 10.1016/j.jclinane.2007.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 09/16/2007] [Accepted: 10/26/2007] [Indexed: 01/29/2023]
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Jeong IM, Woo CH, Kim HS, Kwak IS, Mun SH, Kim HS, Kim KM. Retropharyngeal Laceration during Nasotracheal Intubation - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.5.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Il Man Jeong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Chul Ho Woo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Hyeong Seok Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - In Suk Kwak
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
| | - Sung Ha Mun
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hyun Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Kwang Min Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Korea
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Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth 2006; 53:295-8. [PMID: 16527796 DOI: 10.1007/bf03022218] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Nasotracheal intubation (NTI) has greater potential for trauma of nasopharyngeal mucosa than orotracheal intubation. The present study investigated the success rate of NTI and frequency of nasal bleeding using a curve-tipped suction catheter (CTSC) to guide nasotracheal tube advancement. METHODS Subjects comprised 131 adult patients who under-went NTI. Subjects were randomly divided into two groups: a) NTI under CTSC guidance (G[+] group). The CTSC (14 Fr) was first inserted through the tracheal tube, with the tip of the CTSC emerging from the distal end of the tube. The curved tip was directed ventrally. Both tracheal tube and CTSC were advanced together through the nasopharynx; b) NTI without CTSC guidance (G[-] group). The tracheal tube was advanced into the nasal cavity and passed into the pharynx without CTSC guidance. The time required to pass the endotracheal tube through the nasal cavity (nasal passage time), success rate of nasal passage with nasotracheal tube, and the incidence and severity of nasal bleeding were compared. RESULTS Success rate for nasal passage was 100% in the G(+) group (62/62) and 82.6% in the G(-) group (57/69; P = 0.0006). Frequency of nasal bleeding was significantly lower in the G(+) group (21/62, 33.9%) than in the G(-) group (37/69, 53.6%; P = 0.023). Severity of nasal bleeding was also significantly lower in the G(+) group than in the G(-) group (P = 0.030). CONCLUSIONS Nasotracheal intubation under CTSC guidance increases the success rate of airway instrumentation, and also reduces the incidence and severity of epistaxis.
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Affiliation(s)
- Yoshinari Morimoto
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
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Sinha PK, Kaushik S, Neema PK. Massive epistaxis after nasopharyngeal temperature probe insertion after cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18:123-4. [PMID: 14973821 DOI: 10.1053/j.jvca.2003.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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