Blind nasotracheal intubation is facilitated by neutral head position and endotracheal tube cuff inflation in spontaneously breathing patients.

Abstract

To evaluate, using an endotracheal tube mounted on a flexible lighted stylet, how the patient's head-neck position and inflation of the endotracheal cuff affect correct alignment of the tube tip with the glottis. Eighty-two patients were enrolled. The course of the endotracheal tube in the pharynx was examined by observing the anterior neck for transillumination in each patient under four different intubating conditions. These were: patient's head on pad (8 cm) with the cuff deflated (HP-deflation group); patient's head on pad with the cuff inflated (HP-inflation group); patient's head on bed with the cuff deflated (HB-deflation group); and patient's head on bed with the cuff inflated (HB-inflation group). Both a head on bed (neutral) position or endotracheal tube cuff inflation (15 mL of air) significantly increased the frequency of correct alignment of the tip of the endotracheal tube with the glottis. Blind nasotracheal intubation (BNTI) was successful in 69 patients (84%). Lightwand-assisted nasotracheal intubation was required in 11 of the remaining 13 patients (13%) and fibreoptic bronchoscopy-assisted intubation was performed in the last two patients. A neutral position of the head combined with endotracheal tube cuff inflation is recommended for BNTI.