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Effective nasotracheal intubation using a modified transillumination technique

Intubation nasotrachéale efficace grâce à une technique modifiée de transillumination

Canadian Journal of Anesthesia volume 49, Article number: 91 (2002) Cite this article

Abstract

Purpose

Difficult intubation is a major problem in anesthesia. In case of limited mouth opening only a few intubating devices are available. Our study was designed to evaluate the effectiveness and safety of a modified transillumination technique for nasotracheal intubation (NTI).

Methods

One hundred twenty-three patients needing NTI were studied, 76 in group A: NTI with no expected intubation difficulty; and 47 in group B: limited mouth opening (< 20 mm). All intubations were performed with the Trachlight™. Patients in group A were under general anesthesia while deep sedation (maintaining spontaneous breathing) was used in patients in group B. The standard transillumination technique was modified by keeping the metallic stylet in place and personalizing the length and the angle of the short arm of the J shaped endotracheal tube-transillumination lightwand (ETT-TL) assembly.

Results

The overall rate of success was 98.4% and 92.6% of intubations were successful on the first attempt. The average duration of intubation was 28 sec ± 15 sec. Success rate and duration of intubation were similar in both groups.

Conclusion

Modification of the technique facilitated transillumination and placement of the ETT. The simplicity and high success rate of NTI by transillumination with the TL suggest our modified technique is a valuable alternative for NTI in patients with difficult airway.

Résumé

Objectif

L’intubation difficile est un problème important en anesthésie. Dans les cas d’ouverture buccale limitée, il n’existe que peu d’appareils d’intubation. Notre étude a été conçue pour évaluer l’efficacité et la sécurité d’une technique modifiée de transillumination pour l’intubation nasotrachéale (INT).

Méthode

Cent vingt- trois patients nécessitant une INT ont participé à l’étude, 76 dans le groupe A: INT sans intubation difficile appréhendée et 47 dans le groupe B: ouverture buccale limitée (< 20 mm). Toutes les intubations ont été réalisées à l’aide du Trachlight™. Les patients du groupe A ont reçu une anesthésie générale tandis qu’une sédation profonde a été utilisée pour les patients du groupe B. La technique ordinaire de transillumination a été modifiée en gardant en place le stylet métallique et en ajustant indi — viduellement la longueur et l’angle de la branche courte de l’assemblage du tube lumineux et du tube endotrachéal en forme de J (TL- TET).

Résultats

Le taux global de succès a été de 98,4 % et 92,6 % des intubations ont été réussies au premier essai. La durée moyenne de l’intubation a été de 28 s ± 15 s. Le taux de succès et la durée de l’intubation ont été similaires dans les deux groupes.

Conclusion

La modification de la technique a facilité la transillumination et la mise en place du TET. La simplicité et le haut taux de succès de l’INT par transillumination avec le TL laissent croire que notre technique modifiée soit une solution de rechange valable pour l’INT de patients chez qui l’intubation est difficile.

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Affiliations

  1. Department of Anesthesiology and Intensive Care, University of Rome “La Sapienza”, 837 Via Cassia, 00189, Rome, Italy

    Roberto Favaro, Paolo Tordiglione, Francesco Di Lascio, Donato Colagiovanni, Giancarla Esposito, Sabrina Quaranta & Alassandro Gasparetto

Authors
  1. Roberto Favaro
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  2. Paolo Tordiglione
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  3. Francesco Di Lascio
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  4. Donato Colagiovanni
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  5. Giancarla Esposito
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  6. Sabrina Quaranta
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  7. Alassandro Gasparetto
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Corresponding author

Correspondence to Paolo Tordiglione.

Additional information

This work was supported by the Department of Anesthesia and Intensive Care. University of Rome “La Sapienza”.

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Favaro, R., Tordiglione, P., Di Lascio, F. et al. Effective nasotracheal intubation using a modified transillumination technique. Can J Anesth 49, 91 (2002). https://doi.org/10.1007/BF03020426

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  • DOI: https://doi.org/10.1007/BF03020426

Keywords

  • Rocuronium
  • Alfentanil
  • Difficult Airway
  • Difficult Intubation
  • Insertion Time