Abstract
Background/aim Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methodsAfter Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Results Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90° counterclockwise rotation, external laryngeal pressure, and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand, cuff inflation maneuver must also be kept in mind.
Highlights
Anesthetists have been used to performing nasotracheal intubation during their daily practice since Kuhn’s first description of it in 1902 [1]
Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%)
External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03)
Summary
Anesthetists have been used to performing nasotracheal intubation during their daily practice since Kuhn’s first description of it in 1902 [1]. Since the 1920s, nasotracheal intubation usually has been performed with the Macintosh and the aid of the Magill forceps [2]. Fiberoptic intubation is the gold standard, it is hard to use it in every nasotracheal intubation and it requires technical skill and takes more time than with the Macintosh or videolaryngoscopes. Nasotracheal Airtraq (Airtraq NT; Prodol Meditec S.A., Vizcaya, Spain) is an optical laryngoscope that was designed for nasotracheal intubation procedure without a channel (Figure 1). A new design of video laryngoscopes improved the Cormack–Lehane grade of the patients and allows for nasotracheal intubation without the need of Magill forceps [3,4]
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