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 Table of Contents  
LETTER TO EDITOR
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 51-52

Bougie-aided nasotracheal intubation using Truview laryngoscope: A novel technique


Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication20-Mar-2019

Correspondence Address:
Dr. Neha Singh
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajt.ajt_4_18

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How to cite this article:
Singh N, Rao PB, Raju RB. Bougie-aided nasotracheal intubation using Truview laryngoscope: A novel technique. Afr J Trauma 2017;6:51-2

How to cite this URL:
Singh N, Rao PB, Raju RB. Bougie-aided nasotracheal intubation using Truview laryngoscope: A novel technique. Afr J Trauma [serial online] 2017 [cited 2019 May 22];6:51-2. Available from: http://www.afrjtrauma.com/text.asp?2017/6/2/51/249632



Surgical procedures involving the head and neck may require nasotracheal intubation which is more traumatic than orotracheal intubation. Nasotracheal intubation is technically more difficult than oral intubation, but it has few advantages. It is better tolerated by the patient as nasal route increases comfort for the patient and decreases injury/necrosis of tongue and lips; tube fastening is simpler, thus reducing accidental extubation.[1] The patient cannot bite the tube or manipulate it with the tongue, better oral care, easy stabilization and generally easier oral care. Although the incidence of complications after nasotracheal intubation is reported to be variable, the most common one is epistaxis.[2] Other complications include turbinectomy, retropharyngeal laceration/dissection, intracranial placement through basilar skull fracture, and delayed/unsuccessful placement.[3],[4],[5] Damage of tube cuff with Magill forceps may be associated with direct vision nasotracheal intubation.

We have used bougie-aided nasotracheal intubation technique using Truview laryngoscope. Nostrils were prepared with oxymetazoline drops, and the patient was placed in the “sniffing” position. After induction of anesthesia and adequate mask ventilation, gum-elastic bougie was inserted in the nostril, and Truview laryngoscope was inserted in the mouth to see the tip of the bougie which needs to cross laryngeal inlet [Figure 1]. Most of the times, bougie may be directed to cross the vocal cords using external laryngeal manipulations, but Magill forceps was used at few occasions. Bougie may get obstructed at anterior commissure which can be taken care by rotating it by 90°–180°. A well-lubricated endotracheal tube (ETT) is threaded over it which was directed forward to cross the glottic opening under vision. The bougie was taken out and cuff inflated. Bilateral chest auscultation and capnography trace were checked before fixing the ETT.
Figure 1: Bougie-aided nasotracheal intubation using Truview laryngoscope

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We have used this technique in approximately 900 patients with much reduced risk of cuff injury during nasotracheal intubation.

Nasotracheal intubation can be a potentially traumatic process, and traditionally lower pathway along the floor of the nasal cavity is associated with fewer incidence of trauma.[2],[3] As most of the complications occur during tube advancement through the nostrils and proximal nasopharynx, the complications of both blind and direct-vision nasotracheal intubation are almost the same. However, retropharyngeal laceration and esophageal intubation are more with blind placement, while cuff injury is associated with direct-vision nasotracheal intubation.[2],[5] Lubrication, topical administration of a vasoconstrictor, and thermosoftening of ETTs are some accepted measures to reduce the risk of trauma.[4] In addition, some mechanical techniques have been described to facilitate atraumatic passage of nasotracheal tubes. Kihara et al.[6] reported that epistaxis and postoperative nasal complications were reduced with an expensive, soft- and round-tipped, silicone ETT. Enk et al.[7] reported a reduced incidence of epistaxis using a nasopharyngeal airway as pathfinder during nasotracheal intubation. Here is a newer application of Truview laryngoscope for bougie-aided nasotracheal intubation with reducing the risk of cuff injury and soft-tissue trauma.

Acknowledgment

We would like to thank patient and theater staff.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Holzapfel L. Nasal vs. oral intubation. Minerva Anestesiol 2003;69:348-52.  Back to cited text no. 1
    
2.
Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia 2003;58:249-56.  Back to cited text no. 2
    
3.
Chauhan V, Acharya G. Nasal intubation: A comprehensive review. Indian J Crit Care Med 2016;20:662-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Seo KS, Kim JH, Yang SM, Kim HJ, Bahk JH, Yum KW, et al. A new technique to reduce epistaxis and enhance navigability during nasotracheal intubation. Anesth Analg 2007;105:1420-4.  Back to cited text no. 4
    
5.
Lim CW, Min SW, Kim CS, Chang JE, Park JE, Hwang JY, et al. The use of a nasogastric tube to facilitate nasotracheal intubation: A randomised controlled trial. Anaesthesia 2014;69:591-7.  Back to cited text no. 5
    
6.
Kihara S, Komatsuzaki T, Brimacombe JR, Yaguchi Y, Taguchi N, Watanabe S. A Silicon-based wire-reinforced tracheal tube with a hemispherical bevel reduced nasal morbidity for nasotracheal intubation. Anesth Analg 2003;97:1488-91.  Back to cited text no. 6
    
7.
Enk D, Palmes AM, Van Aken H, Westphal M. Nasotracheal intubation: A simple and effective technique to reduce nasopharyngeal trauma and tube contamination. Anesth Analg 2002;95:1432-6.  Back to cited text no. 7
    


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