Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage

Kim, Yong Chul; Lee, Seung Hwan; Noh, Gyu Jeong; Cho, Sang Yoon; Yeom, Jong Hoon; Shin, Woo Jong; Lee, Dong Hoon; Ryu, Je Seon; Park, Young Sun; Joon, Kyung; Lee, Sang Chul

doi:10.1213/00000539-200009000-00038

Cited by 102 publications

(11 citation statements)

References 6 publications

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“…To prevent this complication, a guided technique using a bougie, suction catheter, or nasogastric tube has been suggested [ 9 , 10 ]; this technique was used in our second attempt. Also, fiber-optic-guided nasotracheal intubation may be a worthy alternative [ 3 , 5 ], besides several other techniques, such as neck extension [ 11 ], nasal tip lifting [ 12 ], and thermosoftening treatment of the nasotracheal tube [ 13 ]. The Parker Flex-Tip nasal endotracheal tube is reported to reduce the incidence of nasal mucosal trauma compared with a conventional tip tracheal tube [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report

et al. 2023

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Background Retropharyngeal dissection is a possible complication during nasotracheal intubation. We report a case of a retropharyngeal dissection extending close to the right common carotid artery occurring while inserting a nasotracheal tube. Case presentation An 81-year-old woman, scheduled for laparoscopic and endoscopic cooperative surgery for a duodenal tumor under general anesthesia, sustained submucosal dissection of the retropharyngeal space during nasotracheal intubation. Postoperative computed tomography revealed retropharyngeal tissue injury extending close to the right common carotid artery. The patient was treated with prophylactic antibiotic therapy and discharged uneventfully on postoperative day 13. Conclusions Submucosal dissection of the retropharyngeal tissue during nasotracheal intubation has a potential risk of major cervical vessel injury. Therefore, when the tip of the tube cannot be visualized within the oropharynx, clinicians must proceed with caution regarding the expected depth of the tube.

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Section: Discussionmentioning

confidence: 99%

Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report

et al. 2023

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“…In addition to the wide applicability of our technique, the other major positive aspect of this modified connector technique is the application of steps to reduce epistaxis including the use of a nasal vasoconstrictor, dilation of the nares with lubricated nasopharyngeal airways, and utilization of a nasal ETT softened in sterile water at 50°C for 20 minutes. 1–3 Also, the use of a NGT as the nasal end of the connection provides advantages over other exchangers because its blunt end, flexibility, and mild rigidity reduce the risk of epistaxis by prepping the preferred lower nasal pathway (between the inferior conchae and nasal floor) for subsequent passage of the nasal ETT. 14…”

Section: Discussionmentioning

confidence: 99%

“…A typical nasal intubation involves preparation of the nares with a vasoconstrictor and administration of an antisialagogue, a routine induction, and intermittent mask ventilation while dilating the nares with lubricated nasal trumpets. Subsequently, a nasal endotracheal tube (ETT) softened in sterile water at 50°C for 20 minutes 1 is placed through a naris into the oropharynx. Direct laryngoscopy (DL) is then used to visualize the distal end of the nasal ETT in the oropharynx and guide it through the glottis via direct manipulation of the tube or with the assistance of a Magill forceps.…”

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confidence: 99%

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Oral to Nasal Endotracheal Tube Exchange: Modification to Enable Wider Applicability of an “Old Connector” Technique—A Case Report

et al. 2023

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Nasotracheal intubation is an essential component of anesthetic management for intraoral and mandibular surgeries. Direct nasotracheal intubation can occasionally be difficult and require an initial oral endotracheal tube (ETT) placement with subsequent conversion to a nasal ETT. Numerous techniques have been described. However, execution can be challenging and limited by available resources. This report re-examines conventional oral to nasal ETT conversion techniques and describes another innovative approach utilizing equipment more readily available in the operating room or as an option when difficulty is encountered with conventional conversion techniques.

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“…3,[5][6][7][8][9] Some textbooks advocated that the left nostril be used for nasotracheal intubation because of less damage to the turbinate from the sharp tube tip, 10,11 some recommend the right nostril because of less epistaxis and shorter intubation times, 3,5,6 and some studies showed no difference in the incidence of epistaxis between the nostrils. 7,9,12 The purpose of this meta-analysis of randomised controlled trials (RCTs) was to try and determine, which nostril is more suitable for nasotracheal intubation when using a tube with a left-facing bevel at the tip in adult surgical patients undergoing general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

For nasotracheal intubation, which nostril results in less epistaxis: right or left?

Tan¹,

Wu²,

Zhao³

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear. OBJECTIVE When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time. DATA SOURCES PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020. ELIGIBILITY CRITERIA The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia. RESULTS Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference −7.28 (−14.40 to −0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference −0.59 (−1.95 to 0.77) s, P = 0.40. CONCLUSION On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time. TRIAL REGISTRATION The study protocol has been registered in PROSPERO (CRD42020169949).

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Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage

Cited by 102 publications

References 6 publications

Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report

Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report

Oral to Nasal Endotracheal Tube Exchange: Modification to Enable Wider Applicability of an “Old Connector” Technique—A Case Report

For nasotracheal intubation, which nostril results in less epistaxis: right or left?

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