Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 11 ( 2016 ) > List of Articles

REVIEW ARTICLE

Nasal intubation: A comprehensive review

Varun Chauhan, Gaurav Acharya

Keywords : Blind nasal intubation, complications, epistaxis, fiber optic, nasotracheal intubation

Citation Information : Chauhan V, Acharya G. Nasal intubation: A comprehensive review. Indian J Crit Care Med 2016; 20 (11):662-667.

DOI: 10.4103/0972-5229.194013

License: CC BY-ND 3.0

Published Online: 01-11-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure.


PDF Share
  1. Kuhn F. Die pernasale tubage. München Med Wochenschr 1902;49:1456.
  2. Macewen W. Clinical observations on the introduction of tracheal tubes by the mouth, instead of performing tracheotomy or laryngotomy. Br Med J 1880;2:163-5.
  3. Gillespie N. Endotracheal Anesthesia. 2nd ed. Maddison, Wiscionsin: University of Wisconsin Press; 1948.
  4. Rosenberg P. Eine Neue Methode der Allgemeinen Narcose. Berl Klin Wchnschr 1895;32:14.
  5. Meltzer SJ, Auer J. Continuous respiration without respiratory movements. J Exp Med 1909;11:622-5.
  6. Elsberg, CA. The value of continuous intratracheal insufflation of air (Meltzer) in thoracic surgery: with description of an apparatus. Med Rec 1910;79:493.
  7. Rowbotham ES, Magill I. Anaesthetics in the plastic surgery of the face and jaws. Proc R Soc Med 1921;14:17-27.
  8. Magill IW. Endotracheal anesthesia. Am J Surg 1936;34:450.
  9. Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia 2003;58:249-56.
  10. McMinn RM. Last's Anatomy. 9th ed. Edinburgh: Churchill Livingstone; 1994. p. 469-73.
  11. Gray LP. Early treatment of septal deformity and associated abnormalities. In: Ellis M, editor. Modern Trends in Diseases of the Ear, Nose and Throat. London: Butterworths; 1972. p. 219-36.
  12. Wang R, Jiang S, Gu R. Nasal septal deviation in fetuses. Zhonghua Er Bi Yan Hou Ke Za Zhi 1996;31:338-40.
  13. Smith JE, Reid AP. Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation. Br J Anaesth 1999;83:882-6.
  14. Patiar S, Ho EC, Herdman RC. Partial middle turbinectomy by nasotracheal intubation. Ear Nose Throat J 2006;85:380, 382-3.
  15. Williams AR, Burt N, Warren T. Accidental middle turbinectomy: A complication of nasal intubation. Anesthesiology 1999;90:1782-4.
  16. Dost P, Armbruster W. Nasal turbinate dislocation caused by nasotracheal intubation. Acta Anaesthesiol Scand 1997;41:795-6.
  17. Scamman FL, Babin RW. An unusual complication of nasotracheal intubation. Anaesthesiology 1983;4:59-60.
  18. Stammberger H, editor. Special endoscopic anatomy of the lateral nasal wall and ethmoidal sinuses. In: Functional Endoscopic Sinus Surgery. Philadelphia: B.C. Dekker; 1991. p. 49-65.
  19. Fell D. The practical conduct of anaesthesia. In: Aitkenhead AR, Smith G, Rowbotham DJ, editors. Textbook of Anaesthesia. London: Churchill Livingstone; 2004. p. 467.
  20. Vaughan RS. Practice of anaesthesia. In: Prys Roberts C, Brown BR, Nunn JF, editors. International Practice of Anaesthesia. Vol. 2. London: Butterworth-Heinemann; 1996. p. 108-6.
  21. Benumof JL, editor. Conventional laryngoscopic orotracheal and nasotracheal intubation. In: Airway Management: Principles and Practice. St Louis, MO: Mosby; 1996. p. 273.
  22. Smith JE, Jackson AP, Hurdley J, Clifton PJ. Learning curves for fibreoptic nasotracheal intubation when using the endoscopic video camera. Anaesthesia 1997;52:101-6.
  23. Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977;47:381-4.
  24. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295-9.
  25. Smith JE, Grewal MS. Cardiovascular effects of nasotracheal intubation. Anaesthesia 1991;46:683-6.
  26. Magill IW. Forceps for intratracheal anaesthesia. Br Med J 1920;2:670.
  27. Hamill M, Toung T. Blind nasotracheal intubations revisited. Anesth Analg 1994;79:390-1.
  28. Gorback MS. Inflation of the endotracheal tube cuff as an aid to blind nasal endotracheal intubation. Anesth Analg 1987;66:916-7.
  29. van Elstraete AC, Pennant JH, Gajraj NM, Victory RA. Tracheal tube cuff inflation as an aid to blind nasotracheal intubation. Br J Anaesth 1993;70:691-3.
  30. King HK, Wooten JD. Blind nasal intubation by monitoring end-tidal CO2. Anesth Analg 1989;69:412-3.
  31. Iseki K, Murakawa M, Tase C, Otsuki M. Use of a modified lightwand for nasal intubation. Anesthesiology 1999;90:635.
  32. Verghese C, Brimacombe JR. Survey of laryngeal mask airway usage in 11,910 patients: Safety and efficacy for conventional and nonconventional usage. Anesth Analg 1996;82:129-33.
  33. Greenberg RS, Brimacombe J, Berry A, Gouze V, Piantadosi S, Dake EM. A randomized controlled trial comparing the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anesthetized adults. Anesthesiology 1998;88:970-7.
  34. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003;98:1269-77.
  35. Rudolph C, Schlender M. Clinical experiences with fiber optic intubation with the Bonfils intubation fiberscope. Anaesthesiol Reanim 1996;21:127-30.
  36. Halligan M, Charters P. A clinical evaluation of the Bonfils intubation fibrescope. Anaesthesia 2003;58:1087-91.
  37. Bein B, Worthmann F, Scholz J, Brinkmann F, Tonner PH, Steinfath M, et al. A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways. Anaesthesia 2004;59:668-74.
  38. Marfin AG, Iqbal R, Mihm F, Popat MT, Scott SH, Pandit JJ. Determination of the site of tracheal tube impingement during nasotracheal fibreoptic intubation. Anaesthesia 2006;61:646-50.
  39. Schwartz D, Johnson C, Roberts J. A maneuver to facilitate flexible fiberoptic intubation. Anesthesiology 1989;71:470-1.
  40. Ovassapian A, Yelich SJ, Dykes MH, Brunner EE. Fiberoptic nasotracheal intubation – Incidence and causes of failure. Anesth Analg 1983;62:692-5.
  41. Nakayama M, Kataoka N, Usui Y, Inase N, Takayama S, Miura H. Techniques of nasotracheal intubation with the fiberoptic bronchoscope. J Emerg Med 1992;10:729-34.
  42. Katsnelson T, Frost EA, Farcon E, Goldiner PL. When the endotracheal tube will not pass over the flexible fiberoptic bronchoscope. Anesthesiology 1992;76:151-2.
  43. Shih CK, Wu CC, Ji TT. One-hand maneuver to facilitate flexible fiber-optic bronchoscope-guided nasotracheal intubation in sedated patients. Acta Anaesthesiol Taiwan 2015;53:150-1.
  44. Venezia D, Wackett A, Remedios A, Tarsia V. Comparison of sitting face-to-face intubation (two-person technique) with standard oral-tracheal intubation in novices: A mannequin study. J Emerg Med 2012;43:1188-95.
  45. Mahajan R, Ahmed P, Shafi F, Bassi R. Dual bougie technique for nasotracheal intubation. Anesth Prog 2012;59:85-6.
  46. Read DH, Du Boulay M. A nasotracheal tube for faciomaxillary surgery. Anaesthesia 1982;37:940-3.
  47. Wright CJ, Frerk CM, Padfield A, Ryan MM, Smith GB. The polyurethane nasotracheal tube. Anaesthesia 1994;49:979-81.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.