Capnography-guided nasotracheal intubation of a patient with a difficult airway and unwanted respiratory depression.

Abstract

W’ e report the combined use of PETCO~ monitoring, low positive pressure ventilation, and endotracheal tube (ETT) cuff inflation to achieve blind nasotracheal intubation of a patient with a difficult airway and midazolam-induced respiratory depression. Nasal mucosa trauma was prevented by inserting a Foley catheter into the ETT with the cuff inflated to provide a smooth tapered end. The ETT tip’s passage from the rhinopharynx to the trachea was facilitated by two consecutive ETT rotations at appropriate insertion lengths. Correct ETT placement was confirmed by both fiberoptic bronchoscopy and a chest roentgenogram.