Nasotracheal intubation in patients with limited mouth opening: a comparison between fibreoptic intubation and the Trachway^®

Abstract

SummaryIn patients with limited mouth opening, traditional laryngoscopy and videolaryngoscopes are not useful when performing nasotracheal intubation. Eighty patients with limited mouth opening who required nasotracheal intubation were randomly assigned to either fibreoptic intubation (n = 40) or the Trachway â (n = 40). Using the modified nasal intubation difficulty scale, 22 (55%) patients who received fibreoptic intubation were categorised as no difficulty compared with 40 (100%) patients in the Trachway group (p < 0.001). Mean (SD) total intubation time was 71.8 (23.3) s in patients who received fibreoptic intubation compared with 35.4 (9.8) s in the Trachway group (p < 0.001). We conclude that the Trachway technique for nasotracheal intubation is quicker and easier compared with fibreoptic intubation in patients with limited mouth opening.

Other anaesthetic uses of fibreoptic bronchoscopy

“…These include: patients with complete trismus; mouth opening < 1.5 cm; severe neck deformities associated with conditions like rheumatoid arthritis or ankylosing spondylitis; and some supraglottic airway tumours. We agree with the other correspondents that published evidence for using a Trachway device in preference to awake fibreoscopy is insufficient [2].…”

“…The recent papers by Lee et al [1] and Ahmad and Bailey [2] discredit fibreoptic intubation. I think such criticism is not justified for several reasons.…”

“…Ahmad and Bailey's [2] contention that fibreoptic intubation is a difficult skill to learn and maintain applies to many anaesthetic techniques. Given that all national airway societies recommend fibreoptic intubation as a 'gold standard' for managing the difficult airway [5], it could be argued that, rather than rejecting the technique out of hand, anaesthetists have a professional duty to master the technique and maintain expertise.…”

Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study

“…To score the intubating conditions after NTI completion, a modified NIDS was used ( Table 1). The total NIDS was categorized as follows: no difficulty (score = 0), mild difficulty (score between 0 and 5), moderate difficulty (score between 6 and 11), or profound difficulty (score of 12 or more) [19].…”

Time to stand up for fibreoptic intubation

“…The recent papers by Lee et al. and Ahmad and Bailey discredit fibreoptic intubation. I think such criticism is not justified for several reasons.…”