Nasotracheal intubation using the Airway Scope and an Endotrol tracheal tube

Abstract

The Airway Scope® (AWS; Hoya-Pentax, Tokyo, Japan) videolaryngoscope, designed for orotracheal intubation, has been shown to be useful in patients with a difficult airway [1]. The AWS has been reported as a useful and safe device for nasotracheal intubation [2]. During conventional nasotracheal intubation using the Macintosh laryngoscope, Magill’s forceps are often required to introduce the tracheal tube through the glottis. However, when the AWS is used for nasotracheal intubation, the AWS blade may obstruct Magill’s forceps. We have previously reported a method for combining the use of the AWS with the fibreoptic bronchoscope [3], and a gum-elastic bougie may also be used to introduce the tracheal tube into the glottis [2, 4]. Herein, we report a new method in which the Endotrol® tracheal tube (Mallinckrodt Medical, Athlone, Co Westmeath, Ireland) is used for nasotracheal intubation with the AWS. The Endotrol tracheal tube has a wire hook that can be used to control the curve of the tube, and has been used successfully in blind intubation [5]. The combination of the Endotrol tracheal tube and a lightwand has been used successfully for nasotracheal intubation [6]. We report the use of this tube with the AWS for nasotracheal intubation. After induction of anaesthesia and establishing mask ventilation, we insert the Endotrol tracheal tube into the patient’s nostril, and the AWS into the patient’s mouth. When the glottis is seen on the monitor, the tube is advanced to the glottis. The tube’s tip may then be directed upward by pulling the wire hook. In our experience with seven cases of nasotracheal intubation using the AWS, the tube can be successfully advanced through the glottis in this manner. We believe the combination of the Endotrol tracheal tube and the AWS is effective for nasotracheal intubation. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.