Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study

Choudhry, Dinesh K.; Brenn, B. Randall; Lutwin-Kawalec, Malgorzata; Sacks, Karen; Nesargi, Susmita; He, Zhaoping

doi:10.1111/pan.12836

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Once in the trachea the ETT is advanced over the bronchoscope [4]. To avoid getting hung up at the arytenoids, a 90°counterclockwise rotation of the ETT has been recommended [150].…”

Section: Endoscopic Intubationmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

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“…Once in the trachea the ETT is advanced over the bronchoscope [4]. To avoid getting hung up at the arytenoids, a 90°counterclockwise rotation of the ETT has been recommended [150].…”

Section: Endoscopic Intubationmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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“…The use of the VL allowed the anesthesiologist to diagnose the cause of the holdup and prevented potential laryngeal damage. Turning the ETT 90 degrees to the left is a well known technique to prevent impingement of the ETT on the laryngeal inlet [39]. Another cause for holdup is the blind loop syndrome when the ETT pulls the FIS out of the trachea to form a blind loop.…”

Section: When To Use a Vl Together With A Fismentioning

confidence: 99%

A Synopsis of Contemporary Anesthesia Airway Management

Bohringer¹,

Duca²,

Liu³

2019

Transl Perioper & Pain Med

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New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.

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“…A nasal endotracheal tube (ETT) is routinely placed when full access to the oral cavity is required for surgical procedures. [1][2][3] Fiberoptic intubation, with limited mouth opening and/or neck mobility, is a useful technique in cases of di cult intubation. [4][5][6] However, advancing the ETT over the beroptic scope is di cult in 0-90% of patients when it hangs up on structures of the laryngeal inlet.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] However, advancing the ETT over the beroptic scope is di cult in 0-90% of patients when it hangs up on structures of the laryngeal inlet. [3,7,8] It may damage the larynx and/or the vocal cord, leading to a postoperative sore throat. [9] Moreover, tracheal intubation failed despite the insertion of the beroptic scope into the trachea because the ETT often impinged at the epiglottis or arytenoid cartilages.…”

Section: Introductionmentioning

confidence: 99%

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

Tsukamoto

Goto

Hitosugi

et al. 2023

Preprint

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

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Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study

Cited by 9 publications

References 17 publications

ERS statement: interventional bronchoscopy in children

ERS statement: interventional bronchoscopy in children

A Synopsis of Contemporary Anesthesia Airway Management

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

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