Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation

Dong, Yingchun; Li, G.; Wu, Wei; Su, Ran; Shao, Yongfeng

doi:10.1016/j.ijom.2013.01.027

Cited by 16 publications

(9 citation statements)

References 14 publications

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“…Such design may have minimized airway distortion 26. Considering the blind nasotracheal intubation–success rate without any lifting force is about 70%, the diminished lifting force may be beneficial in terms of alignment during nasotracheal intubation 27. Taking into account such design features of the Pentax AWS, videolaryngoscope designs with a thinner blade, wider view, and rigid tube requiring less lifting force may be beneficial for nasotracheal intubation…”

Section: Discussionmentioning

confidence: 99%

<p>A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial</p>

Chae

Kim

Park

et al. 2019

TCRM

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PurposeVideolaryngoscopy in nasotracheal intubation has been reported to be better than direct laryngoscopy. The most suitable type of videolaryngoscope remains unknown. This study aimed to compare two videolaryngoscopes (McGrath MAC and Pentax AWS) with a Macintosh laryngoscope during nasotracheal intubation.MethodsOverall, 123 patients older than 18 with normal airways who needed nasotracheal intubation were randomly allocated into three groups: Macintosh (n=41), McGrath (n=41), and Pentax (n=41). Intubation time was the primary outcome and subdivided into three steps: nose to oropharynx, oropharynx to laryngeal inlet, and laryngeal inlet to trachea. Time required, ease of each step, glottic view grade, modified nasal intubation–difficulty score, and subjective difficulty were evaluated.ResultsIntubation time among the three groups was not significantly different (Macintosh 34.6±8.1 seconds, McGrath 35.2±7.9 seconds, Pentax 36.2±9.7 seconds; p=0.727). While the glottal view was better with videolaryngoscopes (I/IIa/IIb/III 36.6%/36.6%/19.5%/7.3% vs 82.9%/9.8%/7.3%/0%, vs 63.4%/29.3%/4.9%/2.4%, p=0.000), modified nasal intubation–difficulty score and subjective difficulty and ease of each step were not significantly different. However, the Pentax took longest for the second step (11.8±6.3 vs 10.3±3.5 vs 15.1±7.6 seconds, p=0.001) but was shortest for the third step (2.9±2.6 vs 4.4±5.6 vs 1.7±0.7 seconds, p=0.001).ConclusionThe McGrath MAC and Pentax AWS showed no benefits in intubation time or difficulty, despite better glottal views, compared to the Macintosh laryngoscope in nasotracheal intubation. Additionally, videolaryngoscopes had variable performance at different steps of nasotracheal intubation.

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Section: Discussionmentioning

confidence: 99%

<p>A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial</p>

Chae

Kim

Park

et al. 2019

TCRM

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“…The lightwand is supplied in various forms, but traumatic events such as airway damage can be prevented by selecting a flexible lightwand suitable for the patient's condition and the skill level of the anesthesiologist [49,50]. 6) Nasotracheal intubation using endotracheal tube introducer (bougie): One or two endotracheal tube introducers can be used when orotracheal intubation is performed.…”

Section: Nasotracheal Intubation After Insertion Through the Nasal Cavitymentioning

confidence: 99%

“…However in obese patients, it is difficult to observe external light. In addition, its use is limited as it is contraindicated in tumors, infections, trauma, and foreign body cases [50,82,83].…”

Section: Lightwandmentioning

confidence: 99%

Nasotracheal intubation for airway management during anesthesia

et al. 2021

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Nasotracheal intubation is used as a basic method for airway management, along with orotracheal intubation under anesthesia and intensive care. It has become an effective alternative method to orotracheal intubation with increased benefits of offering better mobility and surgical field in oral and maxillofacial surgery and possibly in trauma and critically ill patients. Nasotracheal intubation is performed through a relatively narrow nasal cavity; therefore, additional precautions are needed. Accordingly, nasotracheal intubation methods have evolved over the years with accumulated clinical experience and improved instruments to facilitate safe intubation with reduced complications. Therefore, in this review article, we summarize the basic anatomy of the nasal airways to clarify the precautions, delineate the history and development of various methods and instruments, and describe the indications, contraindications, complications, and preventive methods of nasotracheal intubation.

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“…In addition, the illumination of the lightwand is not influenced by blood or secretions, so the lightwand is more effective than the fibreoptic bronchoscope in patients with active bleeding in the oral cavity following facio-maxillary trauma [11]. Lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications [12]. We do not have any experience in using lightwand as it is not easily available in this part of the world, which may be one of its limitations.…”

Section: Fibre-optic Naso-tracheal Intubationmentioning

confidence: 99%

Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons

Jaisani

Pradhan

Bhattarai

et al. 2014

J. Maxillofac. Oral Surg.

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Objective To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided. Material and Methods Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded.Results Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI. In our experience with submental intubation (6 cases), we only had complication related to tube apparatus like damage to pilot balloon. With retrotuberosity intubation (5 cases) we did not encounter any complications and the only limitations were bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive technique has disadvantages like tube interference within the surgical field and not feasible in case of limited retromolar space. Orotracheal-missing dentition intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI is contraindicated, no specialized skill required, no added cost, avoids the need for tracheostomy, no extra-oral procedures required and does not interfere with occlusion/MMF; with disadvantage of occasional tube interference within the surgical field. Conclusion Preferred techniques of securing an airway like orotracheal, nasotracheal may not always be applicable, thus a trauma surgeon-anesthesist team should always have alternative techniques in their armamentarium to reduce the morbidity associated with these patients without interference with occlusion, which is prime goal in jaw fracture reduction. We have used these techniques in a country with limited resources and found them equally effective and convenient to use.

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Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation

Cited by 16 publications

References 14 publications

<p>A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial</p>

<p>A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial</p>

Nasotracheal intubation for airway management during anesthesia

Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons

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