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

Nasotracheal intubation in patients with an unanticipated difficult airway — II

“…Uria et al 1 , and we agree with their assessment that it is important to perform a preliminary laryngoscopy prior to inserting a nasal tube. However, their recommendation to insert a bougie through the RAE® nasal tube, with its distal acute curve, can result in inappropriate bending of the distal portion which is unfavourable to insertion of the bougie into the laryngeal aperture.…”

A two‐bougie technique for safer oro‐ to nasotracheal tube exchange in a difficult airway

“…Several devices and techniques have been described for oro-to naso tracheal tube exchange, such as a tracheal tube exchanger, gum-elastic bougie and flexible fibreoptic bronchoscope [1][2][3]. However, these techniques have disadvantages such as a difficult technique, complex equipment and most importantly, potential for loss of airway control on removal of the oral tube.…”

“…Tracheal extubation may provoke harmful cardiovascular and respiratory complications, such as arterial and venous hypertension, myocardial ischaemia, coughing and straining [2]. We wished to reduce the risks of surgical site bleeding resulting from such pressure changes.…”

“…However, an air ⁄ saline interface within the system can cause an airlock [1,2]. An airlock can compromise this test if the filter is connected before the aspiration test is performed.…”

“…There is a considerable risk of loss of airway control during an oro-to nasotracheal tube exchange in a patient with a difficult airway. Various techniques have been described to negotiate this potentially life-threatening situation safely [1][2][3]. We describe a simple and effective two-bougie technique, which facilitated a safe oro-to nasotracheal tube exchange, in a patient with a known difficult airway.…”