A Silicone-Based Wire-Reinforced Tracheal Tube with a Hemispherical Bevel Reduces Nasal Morbidity for Nasotracheal Intubation

Abstract

The pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with a silicone-based wire-reinforced tracheal tube with a hemispherical bevel than with a polyvinyl chloride-based precurved tracheal tube with a conventional diagonal bevel, but the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube.

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

“…For nasotracheal intubation, additional distance is required for proper positioning at the nares; the reinforced tube may be too short for nasotracheal intubation in some patients. Furthermore, although the preformed tracheal tube is designed to reduce kinking of the tube by a preformed curvature, the wire reinforcement does not extend to the proximal connector, and kinking may occur at this point [10]. In our study, the nasogastric tube-guided technique was advantageous because while a preformed tracheal tube passed through the nasopharynx, the nasogastric tube acted as a guide for the lower pathway; then, after retrieving the nasogastric tube, the preformed tracheal tube could easily be advanced towards the laryngeal inlet.…”

Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view

“…A common complication of nasotracheal intubation is epistaxis, with a reported incidence of 15-80%, depending on a variety of factors including vasoconstrictor drug application to nasal passage, type and size of nasotracheal tube, use of heat-softened tube, and patient characteristics. [3][4][5][6][7][8][9] Because epistaxis can interfere with visualization of the oropharynx and thus impede intubation, a recommendation 2 has been made to assess the airway by direct laryngoscopy prior to passing an endotracheal tube through the nares. If confronted by a potentially difficult airway (Cormack Lehane grade > 2), the airway may be initially secured orally without being impeded by blood in the hypopharynx secondary to epistaxis.…”

Submental Intubation: An Alternative and Cost-Effective Technique for Complex Maxillofacial Surgeries

“…We recommend the use of metal reinforced NG tubes (No. 7-8.5) as there are less chances of kinking resulting in a compromised airway [9].…”

“…Although the cost of reinforced tracheal tubes may seem to be expensive [9] but considering the cost of extended post operative stay in the hospital as an alternative this minor rise in the inventory actually reduces the total cost. Moreover, the post operative care of tracheostomy requires high dependency care in many cases.…”