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J Anaesthesiol Clin Pharmacol 2022 Jan-Mar;38(1):97-103. Epub 2021 Nov 25.

Department of Oncoanaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India.

Background And Aims: Intubation in head and neck carcinoma (HNC) is difficult due to many reasons. Various guidelines recommend strategies for airway management in such anticipated difficult airway cases. However, literature is limited on airway management planning as per the level of difficulty based on airway assessment in these patients. Read More

J Anaesthesiol Clin Pharmacol 2022 Jan-Mar;38(1):124-129. Epub 2021 Dec 1.

Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background And Aims: Awake fibreoptic nasotracheal intubation is associated with adverse airway and hemodynamic complications. The aim of this study was to evaluate the role of endotracheal tube size on nasal and laryngeal morbidity during awake fibreoptic-guided nasotracheal intubation.

Material And Methods: Eighty patients recruited to undergo awake fibreoptic intubation were randomly allocated to Group C (standard size endotracheal tube) and Group S (small size endotracheal tube followed by exchange to standard size using Airway Exchange Catheter under general anesthesia). Read More

Florence Nightingale J Nurs 2022 Jun;30(2):126-132

Department of Nursing Principles, Ege University, Faculty of Nursing, İzmir, Turkey.

Aim: The study aimed to examine pain behavior during nursing interventions in patients who were on mechanical ventilation.

Method: The study was carried out in patients who were under treatment at a university hospital during the 2017-2018 period and who were connected to a mechanical ventilator and were unable to communicate verbally. In two intensive cares (n = 165), 568 pain assessments were made before and during nursing interventions (aspirating the respiratory tract, wound care, injection applications, bed bath, perineal care, mouth care, etc. Read More

Kaohsiung J Med Sci 2022 Jun 1. Epub 2022 Jun 1.

Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Video laryngoscopy is often selected to assist nasotracheal intubation in allowing better laryngeal visualization, although there is no comparative study evaluating the effectiveness between auxiliary techniques by using Magill forceps and inflated cuff in GlideScope video laryngoscopy for nasotracheal intubation. Fifty-one of 100 patients in a Magill forceps group and 47 of 100 patients in a cuff inflation group were included in the final analysis in this randomized, single-blind, parallel, clinical trial study. Induction agents were routinely administered according to body weight, while intubation time spent, attempts, and related side effects were recorded. Read More

Niger J Clin Pract 2022 May;25(5):683-689

Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey.

Background And Aim: Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and glottis visualization of McGrath video laryngoscope with the Macintosh laryngoscope for routine nasotracheal intubation.

Materials And Methods: Records of seventy-one ASA (American Society of Anesthesiologists) I-II patients were evaluated and allocated into two groups (McGrath video laryngoscope (VL) and Macintosh groups). Read More

Niger J Clin Pract 2022 May;25(5):647-652

Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Çankaya, Ankara, Turkey.

Background And Aim: Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration.

Materials And Methods: The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Read More

Oral Surg Oral Med Oral Pathol Oral Radiol 2022 Mar 27. Epub 2022 Mar 27.

Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address:

Objective: This clinical trial was performed to evaluate the effect of nasal tube stabilization (NTS) on the pressure between tube and nose (PTN) in both supine and neck extension positions.

Study Design: This prospective randomized controlled trial recruited 24 American Society of Anesthesiologists physical status I or II adult patients who underwent oral and maxillofacial surgeries requiring nasotracheal intubation. Patients were randomly assigned to intubate with either wire-reinforced or RAE (Ring-Adair-Elwyn) tube. Read More

J Clin Med 2022 Apr 29;11(9). Epub 2022 Apr 29.

Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan.

Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. Read More

Neonatology 2022 29;119(3):402-404. Epub 2022 Apr 29.

Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Gaslini Hospital, Genoa, Italy.

Cureus 2022 Apr 15;14(4):e24171. Epub 2022 Apr 15.

Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, JPN.

Nasotracheal intubation is generally used in maxillofacial and oral surgeries under general anesthesia. However, nasal intubation may cause various complications including epistaxis, retropharyngeal dissection, and intracranial penetration of the nasotracheal tube, which occurs in patients with basal skull defects or fractures. Therefore, nasotracheal intubation is usually contraindicated in such patients. Read More

Pediatr Crit Care Med 2022 Apr 19. Epub 2022 Apr 19.

Department of Pediatrics, University of Utah, Salt Lake City, UT.

Objectives: Nasotracheal intubation (NTI) is associated with fewer unplanned extubations and improved oral motor skills compared with orotracheal intubation (OTI). Our study aimed to implement a practice change from OTI to NTI for neonatal cardiac surgery and assess impact on postoperative outcomes.

Design: Single-center, prospective, quality improvement study. Read More

Cureus 2022 Apr 7;14(4):e23922. Epub 2022 Apr 7.

Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA.

Nasotracheal intubations are an important airway management technique in otolaryngologic surgeries and trauma distorting oropharyngeal structures. For those performing these procedures, nasal deformities are not uncommon. This case report highlights an example of recurrent cuff tears that occurred during nasotracheal intubation of a patient with an unknown nasal bone spur. Read More

J Clin Nurs 2022 Mar 28. Epub 2022 Mar 28.

Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Aims And Objectives: The purpose of this study was to investigate the adverse effects of non-intubated suctioning.

Background: Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. Read More

J Anaesthesiol Clin Pharmacol 2021 Oct-Dec;37(4):542-547. Epub 2021 Nov 25.

Department of Onco-Anesthesiology and Palliative Medicine, BRAIRCH, AIIMS, Ansari Nagar, New Delhi, India.

Background And Aims: Nasotracheal intubation in oropharyngeal cancer patients is challenging owing to anatomical alterations. Various videolaryngoscopes have been compared to conventional laryngoscope and also amongst each other in different clinical scenarios; the supremacy of videolaryngoscopes over conventional laryngoscope in oropharyngeal cancer patients is yet to be established. We compared the efficacy of glidescope videolaryngoscopes and Macintosh laryngoscope for nasotracheal intubation in patients posted for routine oropharyngeal cancer. Read More

Anesth Essays Res 2021 Apr-Jun;15(2):213-219. Epub 2021 Dec 16.

Department of Anaesthesiology and Critical Care, IMS and SUM Hospital, Bhubaneswar, Odisha, India.

Background: Awake fiber-optic bronchoscopy-guided intubation is the method of choice in difficult airway which requires effective airway anesthesia to ensure patient comfort and acceptance.

Aims: This study was conducted to assess the quality of airway anesthesia, patient comfort during intubation, and postoperative satisfaction of patients.

Settings: Patients posted for surgeries under general anesthesia with Mallampati Grade I and II in a medical college. Read More

Sci Rep 2022 03 8;12(1):4041. Epub 2022 Mar 8.

Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.

GlideScope-assisted nasotracheal intubation (NTI) has been proposed as an alternative to difficult orotracheal intubation for critical patients or those under cervical immobilization. We evaluated the difficulty of performing NTI using GlideScope under cervical orthosis. A total of 170 patients scheduled for elective cervical spinal surgery that required NTI were randomized to receive cervical immobilization using a cervical collar (collar group) or no cervical immobilization at all (control group) before anesthetic induction (group assignment at 1:1 ratio). Read More

Neonatology 2022 22;119(3):397-401. Epub 2022 Feb 22.

Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Current recommendations for neonatal endotracheal tube (ETT) insertion depths require the knowledge of anthropometric measurements, which are not immediately available in the delivery room setting.

Objective: This study aimed to develop recommendations based on prenatally available fetal biometric measurements.

Methods: In this retrospective study, the optimal ETT depths for nasotracheal insertion were correlated with fetal demographic and biometric data. Read More

Br J Neurosurg 2022 Jan 11:1-5. Epub 2022 Jan 11.

Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.

Objective: Anterior approach cervical surgery is widely used for accessing C3 lesions. When operating with an anterior approach, the surgical field is obstructed by mandible. Neck extension is popular method to secure better surgical field but risk devastating neurological damage. Read More

Asian J Anesthesiol 2021 12;59(4):152-160

Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

Background: Most of the reports showed that videolaryngoscopy has better outcomes than direct laryngoscopy for nasotracheal intubation. The FKScope® comprises a semirigid and malleable stylet with a terminal camera and has been used to facilitate orotracheal intubation. However, its efficacy and safety for nasotracheal intubation remain unknown. Read More

Anesth Prog 2021 12;68(4):224-229

Professor, Department of Dental Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.

Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Read More

Anaesth Rep 2021 Jul-Dec;9(2):e12142. Epub 2021 Nov 29.

Department of Anaesthesiology Alfred Hospital Melbourne Victoria Australia.

Braz J Anesthesiol 2021 Nov 27. Epub 2021 Nov 27.

University of Medicine and Pharmacy "Iuliu Hatieganu", Anaesthesia and Intensive Care Department, Cluj- Napoca, Romania.

Background: Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases.

Methods: This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Read More

Medicine (Baltimore) 2021 Nov;100(45):e27734

Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea.

Rationale: The main challenge facing anesthesiologists during endotracheal mass resection is securing effective airway management during surgery. It is important to select an airway intubation and airway maintenance method according to the patient's condition and the characteristics of the mass.

Patient Concerns: A 74-year-old woman with aggravated dyspnea for 1 year was scheduled to undergo endotracheal mass excision under general anesthesia. Read More

Indian J Anaesth 2021 Sep 15;65(Suppl 3):S104-S109. Epub 2021 Sep 15.

Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India.

Background And Aims: While performing laryngoscopy during nasotracheal intubation (NTI), the tip of the advancing endotracheal tube (ETT) generally lies along the posterior pharyngeal wall. The inflation of the ETT cuff brings it anterior towards the glottis. The present study was planned to compare the intubating conditions for NTI with standard direct Macintosh laryngoscope versus C-MAC video laryngoscope (VL) employing ETT cuff inflation technique. Read More

Trials 2021 Oct 13;22(1):697. Epub 2021 Oct 13.

Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Huaihe Road 390, Hefei, 230061, China.

Background: Magill forceps are frequently used to complete nasotracheal intubation (NTI). We aimed to identify a tube core that could conveniently facilitate the NTI process without using Magill forceps.

Methods: Sixty patients scheduled for oral and maxillofacial surgeries were enrolled in our study and divided into two groups (30 per group) with no differences with regard to demographic data. Read More

Eur J Anaesthesiol 2021 11;38(11):1180-1186

From the Medical School of Nantong University, Nantong (YLT), Department of Oral Anesthesiology, Nanjing Stomatological Hospital (ZHW, BJZ, YCD) and Central Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China (YHN).

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. Read More

Anesth Prog 2021 10;68(3):154-157

Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

Leaks involving the anesthesia circuit can cause significant complications including hypoxia and hypoventilation. We present a case of a circuit leak caused by damage to the corrugated tubing attributed to improper use of the tube holder. A 58-year-old male was scheduled for resection of a palatal tumor under an intubated general anesthetic. Read More

Front Pediatr 2021 16;9:713516. Epub 2021 Sep 16.

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

The data on long-term nasotracheal intubation among mechanically ventilated critically ill children is limited. The purpose of this study was to compare the rate of post-extubation airway obstruction (PEAO) with nasotracheal and orotracheal intubation. This open-label randomized controlled trial was conducted in PICU of a tertiary care and teaching hospital in North India from January-December 2020 involving intubated children aged 3 months-12 years. Read More

BMC Anesthesiol 2021 09 30;21(1):235. Epub 2021 Sep 30.

Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.

Background: Nasal bleeding is the most common complication during nasotracheal intubation (NTI). To reduce nasal bleeding, the nasal mucosa is treated with vasoconstrictors (epinephrine [E] or tramazoline [T]) prior to NTI. This study aimed to determine whether E or T is more effective and safe for reducing nasal bleeding during NTI. Read More

Ann Afr Med 2021 Jul-Sep;20(3):232-234

Department of Anaesthesiology and Critical Care, All Indian Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Several aids have been designed for helping anesthetist in managing the difficult airway. Oral carcinomas often distort the airway anatomy and present as difficult airway usually with restricted mouth opening. In these scenarios, elective nasotracheal intubation with fiberoptic is done to secure the airway as well as to provide the full surgical field to the surgeon. Read More