Nasotracheal intubation in head and neck surgery. Blind technique in the conscious patient.

Abstract

MANY SURGICAL procedures of the head and neck require nasotracheal intubation for general anesthesia. Intubation is commonly performed after induction using a laryngoscope to visualize the vocal cords. Any of several factors may preclude visualization of the glottis, necessitating blind intubation. In these cases the hazards of epistaxis, laryngospasm, and relaxation of pharyngeal structures are minimized if this is performed with the patient awake. When percutaneous block of the superior laryngeal nerves is supplemented with topical anesthesia of the nose, pharynx, and trachea, intubation may be accomplished with a minimum of discomfort. With food or blood in the stomach, however, the possibility of vomiting and aspiration through an anesthetized airway constitutes an additional hazard. In these cases laryngeal and tracheal anesthesia is omitted so as to retain the normal protective reflexes. Anatomy The larynx is innervated by the vagus nerves through the superior and recurrent laryngeal nerves (Fig 1). The