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A A Pract 2021 May 5;15(5):e01462. Epub 2021 May 5.

From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.

Awake nasotracheal fiberoptic intubations are used to manage difficult airways. Nasopharyngeal airways can be placed into the nostril to facilitate fiberoptic intubation and has been shown to be a useful pathfinder. We describe a case where this nasopharyngeal airway was inadvertently advanced with the bronchoscope and led to partial tracheal obstruction. Read More

Braz J Anesthesiol 2021 Apr 28. Epub 2021 Apr 28.

Shahid Beheshti University of Medical Sciences, National Research Institute of Tuberculosis and Lung Diseases, Tracheal Diseases Research Center, Tehran, Iran.

Background: Correct endotracheal intubation results in better ventilation, prevents hypoxia and its possible damages, such as brain injury, and minimizes attempts for re-intubation. Up to now, several formulas have been published to estimate nasotracheal intubation tube length. This study aims to compare the accuracy of different suggested formulas to find the one that better estimates the tube insertion distance. Read More

BMC Anesthesiol 2021 Apr 22;21(1):126. Epub 2021 Apr 22.

Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea.

Background: Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. Read More

J Dent Anesth Pain Med 2021 Apr 31;21(2):167-171. Epub 2021 Mar 31.

Department of Anesthesiology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA.

We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. Read More

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):477-482. Epub 2021 Jan 18.

Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India.

Background And Aims: The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries.

Material And Methods: We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). Read More

BMC Anesthesiol 2021 Mar 9;21(1):72. Epub 2021 Mar 9.

Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea.

Background: Nasal intubation is indispensable for some cases that require intraoral surgical access, and the fiberoptic bronchoscope is the best tool for difficult airways. However, fiberoptic bronchoscopy is not always possible in cases with altered pharyngeal anatomy.

Case Presentation: In this report, we introduce a novel technique for retrograde endotracheal oral-to-nasal conversion with an ordinary endotracheal tube exchange catheter. Read More

Paediatr Anaesth 2021 Mar 12. Epub 2021 Mar 12.

Department of Anesthesia, University Children's Hospital, Zurich, Switzerland.

Background: In clinical practice, the cuff inflation line of cuffed pediatric tracheal tubes often interferes with securing tracheal tubes.

Methods: The insertion site of the cuff inflation lines and the lengths of four different brands and nine sizes of commonly used cuffed pediatric tracheal tubes were measured and compared in vitro with oral and nasotracheal intubation depths as calculated by different formulas for pediatric patients aged from birth to 16 years. Motoyama's recommendation was used for age-related size selection of cuffed pediatric tracheal tubes. Read More

PLoS One 2021 8;16(3):e0248296. Epub 2021 Mar 8.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

When selecting the nasotracheal tube diameter for nasotracheal intubation, atraumatic introduction of the tube through the nasal passage and a safe location of the tube's cuff and tip should be ensured simultaneously. To maintain safety margin for the tube's cuff and tip from the vocal cords and carina (2 cm and 3 cm, respectively), the maximum allowable proximal-cuff-to-tip distance was calculated as 5 cm less than the measured vocal cords-to-carina distance. The primary aim of this study was to find a single predictive preoperative factor of the nostril size and maximum allowable proximal-cuff-to-tip distance of nasotracheal tubes. Read More

Dysphagia 2021 Feb 23. Epub 2021 Feb 23.

Department of Anesthesiology, Taipei Veterans General Hospital and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan.

Nasotracheal intubation benefits dysphonia recovery after anterior cervical spine surgery (ACSS). The aim of the present study was to investigate the effect of tracheal intubation modes on post-ACSS swallowing function and identify factors associated with deglutition on postoperative day 30 (POD 30). Adult patients were randomized to receive either nasotracheal or orotracheal intubation during surgery. Read More

J Med Case Rep 2021 Feb 15;15(1):66. Epub 2021 Feb 15.

Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe-City, Hyogo, 650-0047, Japan.

Background: Acquired hemophilia A is a rare coagulopathy caused by inhibitors of blood coagulation factor VIII. Patients with acquired hemophilia A have a higher mortality risk (5-10%) than those with congenital hemophilia. Moreover, there is no established evidence of management recommended for patients with acquired hemophilia A. Read More

Anesth Essays Res 2020 Apr-Jun;14(2):271-276. Epub 2020 Oct 12.

Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.

Background: Awake fibreoptic nasotracheal intubation is an effective technique for the management of patients with difficult airways. Adequate sedation with effective topicalization of the airway is important to overcome discomfort and achieve intubation successfully.

Aim And Objectives: Our aim was to compare the effectiveness of dexmedetomidine-midazolam with fentanyl-midazolam infusion for providing conscious sedation during fibreoptic intubation in patients with anticipated difficult airway under topical anaesthesia. Read More

Saudi J Anaesth 2020 Oct-Dec;14(4):549-550. Epub 2020 Sep 24.

Senior Clinical Fellow in Anaesthesia, Department of Anaesthesia, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK.

Ann Plast Surg 2021 02;86(2S Suppl 1):S84-S90

From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.

Background: Dexamethasone (Dexa) is frequently administrated to patients receiving head and neck microsurgical reconstruction with nasotracheal intubation postoperatively for airway control. Infection is the greatest concern when prolonging the treatment course. We aimed to find out the relationship between flap infection and the safe dose of Dexa. Read More

Anesth Prog 2020 12;67(4):193-199

Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. Read More

Asian Pac J Cancer Prev 2020 Dec 1;21(12):3613-3617. Epub 2020 Dec 1.

Department of Oral & Maxillofacial Surgery, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, India.

Background: Patients with intra-oral malignancies warrants use of awake Fiberoptic assisted naso-thracheal intubation to secure an airway due to multiple risk factors leading to anticipated difficult airway. Different techniques such as airway blocks, local anesthesia (LA) gargles, spray, nebulization and  mild  sedation are in practice to improve  the success rate of fiberoptic assisted intubation.

Methods: Sixty patients  of  ASA I and II with Mallampatti score 3 and above, posted for Commando operations were enrolled in this study and were divided into 2 groups. Read More

Front Vet Sci 2020 27;7:587524. Epub 2020 Nov 27.

Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.

Rabbit inhalation anesthesia by endotracheal intubation involves a higher risk among small animals owing to several anatomical and physiological features, which is pathognomonic to this species of lagomorphs. Rabbit-specific airway devices have been designed to prevent misguided intubation attempts. However, it is believed that expert anesthetic training could be a boon in limiting the aftermaths of this procedure. Read More

Anesth Pain Med (Seoul) 2020 Jan;15(1):73-77

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: Patients with hemifacial microsomia may have a difficult airway due to the accompanying mandibular deformity. Fiberoptic bronchoscope-guided intubation is commonly used method for difficult airway management. However, awake fiberoptic nasotracheal intubation has several disadvantages, including difficulty in advancement of the endotracheal tube (ETT) due to the resistance between the ETT and bronchoscope. Read More

BMJ Case Rep 2020 Dec 13;13(12). Epub 2020 Dec 13.

Anaesthesiology, Dr RML Hospital and PGIMER, New Delhi, Delhi, India.

Nasotracheal intubation can be challenging due to undesirable incidence of nasal bleeding and soft tissue injuries. The bleeding can obscure glottis visualisation, increase the total intubation time, the risk of aspiration and oxygen desaturation. Total control introducer is a new airway adjunct with a flexible shaft, articulating tip and an intuitive depth control system, which can be used in difficult airway scenarios to improve the success of nasal intubations. Read More

AANA J 2020 Dec;88(6):459-463

is a staff nurse anesthetist at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Email:

This case report describes a right arytenoid dislocation after emergency fiberoptic nasotracheal intubation in a patient with angioedema. The patient returned to the emergency department multiple times with classic symptoms of arytenoid dislocation, complicated by resultant postinjury laryngeal edema and poorly controlled laryngopharyngeal reflux. The arytenoid injury was not initially recognized, which delayed treatment. Read More

J Dent Anesth Pain Med 2020 Oct 30;20(5):293-301. Epub 2020 Oct 30.

Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea.

Background: The success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI). Read More

Bull Tokyo Dent Coll 2020 Dec 10;61(4):275-279. Epub 2020 Nov 10.

Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital.

Since 2018, we have been using a 3D printer to fabricate a proprietary device for fixing nasotracheal tubes. The aim of this retrospective study was to investigate the impact of this nasotracheal intubation (NTI) fixation device. It has been used in 335 patients undergoing general anesthesia for oral and maxillofacial surgeries. Read More

Pediatr Crit Care Med 2020 11;21(11):1024-1025

Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Natl J Maxillofac Surg 2020 Jan-Jun;11(1):40-45. Epub 2020 Jun 18.

Department of Anaesthesiology, KGMU, Lucknow, Uttar Pradesh, India.

Introduction: Securing a difficult airway during maxillofacial surgeries is a great challenge for anesthetists, and the flexible fiber-optic bronchoscope is the gold standard while managing such cases. While passing the flexible bronchoscope by the nasal route, the success rate is higher as compared with oral approach as the nasopharynx is in line with the larynx and prevents acute angulation in the oropharynx.

Materials And Methods: A randomized control trial was planned in 73 patients out of whom sixty patients gave consent for the procedure. Read More

J Vasc Surg 2021 May 8;73(5):1675-1682.e4. Epub 2020 Oct 8.

Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Objective: Carotid endarterectomy (CEA) is a proven intervention for stroke risk reduction in symptomatic and asymptomatic patients. High-risk patients are often offered carotid stenting to minimize the risk and optimize the outcomes. As a referral center for high-risk patients, we evaluated and analyzed our experience with high-risk CEA patients. Read More

Surg Neurol Int 2020 5;11:277. Epub 2020 Sep 5.

Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University, Rabat, Morocco.

Background: Superior laryngeal nerve block (SUPLANEB) is a popular airway anesthesia technique utilized for successful awake endotracheal intubation in patients with significant cervical spine instability. If not performed by an expert, it carries the risk of general/neurologic complications that are typically minimal/transient. However, permanent blindness and/or upper cranial nerve neuropathies may occur. Read More

Eur J Anaesthesiol 2021 Feb;38(2):157-163

From the Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea (DW, HK, JEC, JML, SWM, JYH, TKK), Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (JJ, HJY).

Background: For nasotracheal intubation, the nasal pathway between the inferior turbinate and hard palate (lower pathway) is preferred for patient safety. However, selecting the lower pathway can be challenging because passage of the tube through the nasal pathway is usually performed blindly.

Objectives: We investigated whether facing the bevel of the tracheal tube in the cephalad direction of the patient could help in advancing the tracheal tube through the lower pathway during nasotracheal intubation. Read More

Anesth Prog 2020 09;67(3):174-176

Department of Anesthesiology, Nihon University School of Dentistry, Tokyo, Japan.

A patient undergoing a bilateral sagittal split and LeFort 1 maxillary osteotomy performed under general anesthesia required emergent intraoperative exchange of a potentially damaged nasotracheal tube. This exchange was smoothly performed under constant indirect visualization using the McGrath MAC video laryngoscopy system. After the exchange, ventilation of the patient dramatically improved. Read More

J Clin Anesth 2021 Feb 25;68:110070. Epub 2020 Sep 25.

Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan. Electronic address:

Photodiagnosis Photodyn Ther 2020 Dec 16;32:102028. Epub 2020 Oct 16.

University of Health Sciences Antalya Training and Research Hospital, Department of Endocrinology and Metabolism, Antalya, Turkey.

Background: Indocyanine green fluorescence (ICG) angiography has been used for many purposes including as part of a focused parathyroidectomy technique. Concomitant fluorescence of thyroid tissue may cause challenges defining parathyroid tissue during surgery, since ICG is not a selective fluorescent agent. On the other hand, cosmesis is still a big problem for patients due to the visible neck scars produced by the standard surgical technique. Read More

J Oral Maxillofac Surg 2021 Jan 27;79(1):89.e1-89.e9. Epub 2020 Aug 27.

Assistant Professor in Anesthesiology, Department of Oral and Maxillofacial Surgery, Erciyes University, Kayseri, Turkey.

Purpose: Nasotracheal intubation (NTI) is generally preferred for maxillofacial surgery to provide a more suitable and wide surgery area for the surgeons. The purpose of the study was to evaluate whether using a nasal airway just before the NTI may facilitate NTI or not.

Methods: This prospective, randomized, and controlled study was performed on patients who were admitted to our hospital for maxillofacial surgery. Read More