Awake light-aided blind nasal intubation: prototype device

Abstract

Limited mouth opening associated with unavailable or ineffective fibreoptic bronchoscope (FOB) is an intubation challenge. A light-aiding device may facilitate the blind nasal intubation. Awake blind nasal intubation was planned for 16 elective patients with inaccessible oral route (three children and 13 adults, ASA I-II). Topical anaesthesia for the supraglottis, glottis, and upper trachea was performed using prototype supraglottic topical anaesthesia device and cricothyroid injection of local anaesthesia. Hand-made light-aiding intubation device was used to help blind nasal intubation. Three attempts of blind nasal intubation (60 s each) were allowed, otherwise failure and FOB intubation were considered. During the procedure, heart rate, mean arterial pressure, and arterial oxygen saturation (Spa(o(2))) were measured. Temperature created at the bulb surface of the device was measured for 4 min duration, with and without exposing the bulb to oxygen flow of 6 litre min(-1). All the patients were successfully intubated except one child. Time to intubate in adults was mean (sd) 52.7 (8.6) s. Spa(o(2)) showed significant difference between before and after procedural values. The maximum temperature recorded at the bulb surface was 46.8 (0.4) degrees C and 48.1 (0.8) degrees C with and without oxygen flow, respectively. The device appeared to be a safe and cost-effective transillumination method for blind nasal intubation in difficult airways.