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Nasotracheal Intubation (nasotracheal + intubation)
Selected AbstractsNasotracheal intubation for head and neck surgeryANAESTHESIA, Issue 11 2003R Williamson No abstract is available for this article. [source] Submental intubation in complex craniomaxillofacial traumaANZ JOURNAL OF SURGERY, Issue 5 2004Charles Davis The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. A submental intubation has been used in 11 selected cases amongst 190 consecutively treated patients with craniomaxillofacial trauma over a 3-year period. These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described. [source] Combining the EndoFlex® tube with fiberoptic bronchoscopy in difficult intubationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009K. SUGIYAMA We applied a combination technique using the EndoFlex® tube with fiberoptic bronchoscopy for a 69-year-old man presenting with limited mouth opening and neck movement. Awake nasotracheal intubation was performed under conscious sedation with propofol and fentanyl. After positioning the tip of the EndoFlex® tube in the oropharynx, the fiberoptic bronchoscope was inserted into the tube until the tip reached the bevel of the tube. Anterior flexion of the distal tip of the EndoFlex® tube facilitated uncomplicated insertion of the tube into the trachea without impingement on the arytenoids. Fiberoptic visualization confirmed that the distal-tip flexing mechanism of the EndoFlex® tube corrected the direction of the tube tip anteriorly, allowing entry into the trachea. We present a case where this technique proved valuable for tracheal intubation in a patient with limitations of mouth opening and neck movement. [source] What to do if the endotracheal tube will not pass through the nasal passage during fiberoptic nasotracheal intubationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2007S. W. Na No abstract is available for this article. [source] Digitally assisted nasotracheal intubationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2005R. Mahajan No abstract is available for this article. [source] Variation in the Type, Rate, and Selection of Patients for Out-of-hospital Airway Procedures Among Injured Children and AdultsACADEMIC EMERGENCY MEDICINE, Issue 12 2009Craig D. Newgard MD Abstract Objectives:, The objective was to compare the type, rate, and selection of injured patients for out-of-hospital airway procedures among emergency medical services (EMS) agencies in 10 sites across North America. Methods:, The authors analyzed a consecutive patient, prospective cohort registry of injured adults and children with an out-of-hospital advanced airway attempt, collected from December 1, 2005, through February 28, 2007, by 181 EMS agencies in 10 sites across the United States and Canada. Advanced airway procedures were defined as orotracheal intubation, nasotracheal intubation, supraglottic airway, or cricothyrotomy. Airway procedure rates were calculated based on age-specific population values for the 10 sites and the number of injured patients with field physiologic abnormality (systolic blood pressure of ,90 mm Hg, respiratory rate of <10 or >29 breaths/min, Glasgow Coma Scale [GCS] score of ,12). Descriptive measures were used to compare patients between sites. Results:, A total 1,738 patients had at least one advanced airway attempt and were included in the analysis. There was wide variation between sites in the types of airway procedures performed, including orotracheal intubation (63% to 99%), supraglottic airways (0 to 27%), nasotracheal intubation (0 to 21%), and cricothyrotomy (0 to 2%). Use of rapid sequence intubation (RSI) varied from 0% to 65%. The population-adjusted rates of field airway intervention (by site) ranged from 1.2 to 22.8 per 100,000 adults and 0.2 to 4.0 per 100,000 children. Among trauma patients with physiologic abnormality, some sites performed airway procedures in almost 50% of patients, while other sites used these procedures in fewer than 10%. There was also large variation in demographic characteristics, physiologic measures, mechanism of injury, mode of transport, field cardiopulmonary resuscitation, and unadjusted mortality among airway patients. Conclusions:, Among 10 sites across North America, there was wide variation in the types of out-of-hospital airway procedures performed, population-based rates of airway intervention, and the selection of injured patients for such procedures. [source] Is the intubating laryngeal mask tube really superior to the flexometallic tracheal tube for fibreoptic nasotracheal intubation?ANAESTHESIA, Issue 4 2010F. S. Xue No abstract is available for this article. [source] The Parker Flex-TipTM tube for nasotracheal intubationANAESTHESIA, Issue 4 2010F. S. Xue No abstract is available for this article. [source] A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubationANAESTHESIA, Issue 3 2010C.-J. Tsai Summary Fibreoptic intubation is a valuable modality for airway management. This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 ,g.kg,1 over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1,2 [1,4]) in the dexmedetomidine group and 3 (2,4 [2,5]) in the propofol group (p = 0.027), favouring the former. The dexmedetomidine group experienced fewer airway events and less heart rate response to intubation than the propofol group (p < 0.003 and p = 0.007, respectively). Both dexmedetomidine and propofol target-controlled infusion are effective for fibreoptic intubation. Dexmedetomidine allows better tolerance, more stable haemodynamic status and preserves a patent airway. [source] The Parker Flex-TipÔ tube for nasotracheal intubation: the influence on nasal mucosal traumaANAESTHESIA, Issue 1 2010T. Sanuki Summary We tested our hypothesis that use of the Parker Flex-TipÔ tracheal tube could reduce the incidence of nasal mucosal trauma during nasotracheal intubation when compared with a conventional tip tracheal tube. One hundred and two patients, who were scheduled for elective oral surgery in which nasotracheal intubation was indicated to optimise the surgical approach, were recruited into this study. Either a Flex-Tip tracheal tube or a conventional tip tracheal tube was chosen randomly for each nasotracheal intubation. The incidence of epistaxis using the Flex-Tip tracheal tube (6 (11.8%)) was significantly lower than that with the conventional tip tracheal tube (18 (35.3%); p = 0.009). Nasal pain due to intubation, rated on a 100-mm visual analogue scale, was less intense with the Flex-Tip tracheal tube (median, (10th,90th percentile) 19 (12,28) mm compared with the conventional tip tracheal tube (30 (22,35) mm; p < 0.001). The Flex-Tip tracheal tube thus appeared to reduce the incidence of nasal mucosal trauma during nasotracheal intubation and the incidence of post-intubation nasal pain, compared with the conventional tip tracheal tube. [source] Airway Scope® -assisted nasotracheal intubationANAESTHESIA, Issue 2 2009H. Kitagawa No abstract is available for this article. [source] The use of propofol and remifentanil for the anaesthetic management of a super-obese patientANAESTHESIA, Issue 8 2007L. La Colla Summary Morbid obesity is defined as body mass index (BMI) >,35 kg.m,2, and super-obesity as BMI >,55 kg.m,2. We report the case of a 290-kg super-obese patient scheduled for open bariatric surgery. A propofol-remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. Servin's weight correction formula was used for propofol. Arterial blood samples were taken at fixed time points to assess the predictive performance of the TCI system. A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol-remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index-guided propofol-remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery. [source] Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three casesANAESTHESIA, Issue 3 2006M. K. Arora Summary Management of a difficult paediatric airway is challenging, and the unavailability of a paediatric fibreoptic bronchoscope, a common limitation in developing countries, adds to these difficulties. Children with bilateral temporomandibular joint ankylosis have limited mouth opening and therefore direct laryngoscopy and intubation is not usually possible. In the absence of sophisticated fibreoptic equipment, blind nasal intubation remains the only non-surgical option for control of the airway. Blind nasal intubation in paediatric anaesthesia is difficult. We describe a novel method of blind nasal intubation in paediatric patients using a gum elastic bougie. We have used this method successfully in three patients in whom tracheal intubation using a conventional blind nasal approach was unsuccessful. In view of its reliability and the absence of any soft tissue injury, we propose the use of this novel technique as an alternative to conventional blind nasal intubation, when more sophisticated fibreoptic equipment is not available. [source] Nasal endoscopy prior to nasotracheal intubationANAESTHESIA, Issue 3 2002S. Singh No abstract is available for this article. [source] In reply to the letter to the editor ,What to do if the endotracheal tube will not pass through the nasal passage during fiberoptic nasotracheal intubation'ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2008J. Punj No abstract is available for this article. [source] | ||||||||||