Seldinger technique for nasal intubation: a case series

Abrons, Ron O.; Vansickle, Ryan A.; Ouanes, Jean Pierre P.

doi:10.1016/j.jclinane.2016.06.027

Cited by 12 publications

(15 citation statements)

References 6 publications

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“…Furthermore, performing NTI under suction catheter guidance represents a simple and effective method for smoothly introducing a nasal endotracheal tube and reducing nasal bleeding during NTI [16]. In other studies, the placement of a bougie through a nasopharyngeal airway may also act to protect the nasal mucosa and guide the tracheal tube and was associated with less epistaxis as well as better navigability and a lower redirection rate [3,17]. In the present study, no moderate or severe epistaxis occurred in either group, perhaps for the following reasons: each nostril was preestimated for size and patency by fiberoptic bronchoscopy, and five drops of 1 % ephedrine solution were instilled into the larger nasal cavities to prevent bleeding.…”

Section: Discussionmentioning

confidence: 99%

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

et al. 2019

Preprint

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Background Nasotracheal intubation (NTI) is frequently performed in oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fiberoptic bronchoscopy. Methods Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fiberoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time were recorded. Epistaxis was recorded using direct laryngoscopy ﬁve minutes after completing NTI. Results The time to complete NTI was significantly longer in the fiberoptic group than the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% CI, 10.4 to 18.1). In addition, Mild epistaxis (nasal bleeding) was observed in 8 patients in the fiberoptic group and 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9). No moderate or severe epistaxis occurred in either group. Furthermore, there was no obvious nasal pain at any time point after extubation in the Disposcope group, and there was no significant difference between the two groups. Conclusion NTI can be completed successfully using either fiberoptic bronchoscopy or a Disposcope endoscope as a guide without any severe adverse reactions. However, compared to fiberoptic bronchoscopy, the Disposcope endoscope requires less transaction time.

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Section: Discussionmentioning

confidence: 99%

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

et al. 2019

Preprint

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“…Instead of the red rubber catheter being used to guide the tracheal tube through the nostrils and into the pharynx, the paediatric bougie guides the tracheal tube through the nostril, pharynx and glottis. Not having to orally manipulate the tube is advantageous in two ways: there is no risk of trauma to the tube or airway from oropharyngeal manipulation of forceps; and in cases where the oropharynx lacks the room for manipulation of forceps, the tracheal tube can still be safely guided via external manipulation of the bougie [16].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we propose an alternative for routine post-induction nasotracheal intubation, specifically, nasotracheal intubation over a bougie placed via a nasopharyngeal airway ('bougie technique') and evaluate its effectiveness. This Seldinger-based technique builds upon earlier work of bougie-guided nasal intubation [14][15][16] with the addition of a nasopharyngeal airway, which acts to protect the nasal cavity and direct the bougie towards the glottis. We conducted a prospective, randomised trial comparing the bougie and the conventional techniques, with the hypothesis that the bougie technique would result in less nasal trauma than the conventional technique.…”

Section: Introductionmentioning

confidence: 99%

Nasotracheal intubation over a bougie vs. non‐bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy

2017

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Conventionally, nasotracheal intubation has consisted of blind nasal passage and external manipulation of the tube through the glottis ('conventional technique'), a technique associated with a high incidence of nasal trauma. We evaluated a novel technique for routine asleep (i.e. post-induction) nasotracheal intubation using a bougie ('bougie technique'), which uses a nasopharyngeal airway to guide a paediatric bougie nasotracheally for use as a Seldinger tracheal intubation guide. Two hundred and fifty-seven older children (> 8 years) and adults were randomly assigned to videolaryngoscopy-assisted nasotracheal intubation using either the conventional or the bougie technique. The hypothesis was that the bougie technique would result in less nasopharyngeal trauma. The bougie technique was associated with significantly less nasopharyngeal bleeding than the conventional technique at both 60-90 s (55% vs. 68%; p = 0.033) and 5 min (51% vs. 70%; p = 0.002). The severity of bleeding was also significantly less with the bougie technique, with an OR for active bleeding of 0.42 (95%CI 0.20-0.87; p = 0.020) at 60-90 s and 0.15 (95%CI 0.06-0.37; p < 0.0001) at 5 min. Magill forceps were needed significantly less often with the bougie technique (9% vs. 28%, p = 0.0001) and there was no difference in first attempt and overall success rates between the two techniques (p = 0.133 and p = 0.750, respectively). Not only is nasal intubation over a bougie as successful as the conventional technique, it also significantly decreases both the incidence and severity of nasopharyngeal trauma, as well as the need for the use of Magill forceps.

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“…The authors discussed how the use of a nasal bougie can guide tubes through narrow nasal passages and small pharyngeal spaces without transoral manipulation [19]. The use of an esophageal stethoscope for NTI also proved to be effective as well in reducing epistaxis and reducing trauma in a randomized control study from Seoul University School of Dentistry [18].…”

Section: Summary Of the Literaturementioning

confidence: 99%

A Safer Technique for Nasal Intubation: A Literature Review

Lera¹,

Machan²,

Derefaka³

2017

OJAnes

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Nasotracheal intubation (NTI) is the most widely used method to establish an airway during anesthesia for oral surgery. It has the advantage of providing exceptional accessibility and optimal working conditions in the oral cavity for surgeons. Anesthesia providers are highly trained in managing and securing the airway. Because the oral intubation route is the most widely used technique for securing the airway, nasal intubation can be cumbersome for anesthetists who do not routinely perform this skill. Moreover, anesthesia providers who do not routinely perform NTI may feel apprehension out of concern for nasopharyngeal bleeding and trauma. The number of dental and oromaxillofacial procedures requiring nasal intubation has been steadily growing annually. Although NTI is generally safe, it still presents a risk for complications. The purpose of this literature review was to examine current literature and evidence-based practices of NTI to determine whether the use of a catheter-guided technique will improve patient care outcomes by way of decreased trauma to the airway compared to current clinical practices. The goal of this review is to recommend the use of a catheter-guided technique for NTI as the preferred method for securing the airway during oral surgery as it is less traumatizing to the airway than conventional methods.

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Seldinger technique for nasal intubation: a case series

Cited by 12 publications

References 6 publications

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

Nasotracheal intubation over a bougie vs. non‐bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy

A Safer Technique for Nasal Intubation: A Literature Review

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