An alternative anesthetic technique can be employed when conventional nasal intubation methods do not work in patients undergoing dental procedures or oral surgery. The method involves a gum elastic bougie (GEB) device, which is useful for difficult airway management but seldom has been used for nasotracheal intubation (Anesthesia Progress, Fall 2010, Vol. 57:3, pp. 112-113).
Researchers from Kanagawa Dental School described how this application of GEB for nasal endotracheal intubation was performed in 16 patients whose tracheas could not be intubated by conventional techniques because of anatomical problems or misdirection of the tip of the tracheal tube. These patients were among 632 people undergoing dental procedures or oral surgery.
The authors explain how to place and connect the nasal tube for optimal use. They note that the use of several other mechanical aids -- including suction catheters, nasogastric tubes, stylets, and nasal flexible laryngeal masks -- has been reported previously for nasal intubation.
In instances when mouth opening is limited or prohibited, fiber-optic intubation can be an effective approach to intubation, the researchers wrote, although they have found it to be time-consuming. Because of this, they suggest application of GEB as a good alternative.
"In our experience with use of these methods, this GEB technique is very quick, safe, inexpensive, and easy to perform," the authors concluded. "Thus, we recommend the use of GEB from the first attempt for nasal endotracheal intubation in patients with difficult airways."
Copyright © 2010 DrBicuspid.com
