Pathological changes associated with short-term nasal intubation

Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2016

Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowl...

BMC Anesthesiology, 2021

Background: Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. However, little is known about the follow-up of patients after these complications. Case presentation: The present case describes an accidental middle turbinectomy that led to endotracheal tube obstruction during nasotracheal intubation, and discusses its long-term follow-up. A 19-year-old man underwent mandibular surgery under general anesthesia and nasotracheal intubation. His right middle turbinate was completely avulsed and became firmly occluded within the tube during nasotracheal intubation. The nasotracheal intubation was performed again and the operation was completed safely. The patient was discharged without sequelae after postoperative care. However, he had symptoms of nasal obstruction and sleep disturbance for 3 months postoperatively. Synechiae were detected between the nasal septum and lateral nasal wall on a right rhinoscopic examination and facial computed tomography at 3 months postoperatively. Additionally, he showed ipsilateral maxillary sinusitis on facial computed tomography at the 2-year follow-up examination. Conclusions: Nasotracheal intubation can cause late complications as well as early complications. Therefore, if nasotracheal intubation is to be performed, the anesthesiologist should identify the nasal anatomy of the patient accurately and prepare appropriately. In addition, if complications occur, follow-up observation should be performed.

Ibnosina Journal of Medicine and Biomedical Sciences, 2014

Background: Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia. The procedure for intubation involves achieving neuromuscular blockade followed by passing the endotracheal tube (ETT) into the trachea. Objectives: Our hypothesis was that the nasopharyngeal passage of the endotracheal tube can be facilitated by the finger of a sterile glove acting as a pathfinder. Patients and Methods: We performed a randomized controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, the tip of the ETT was inserted into the finger of a sterile glove before the ETT was inserted into the more patent nostril. In the control group (n=40), the gloves finger was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter: 7.0 mm). In the intervention group (n=40), the finger of a sterile glove was kept in position. The tip of the endotracheal tube is inserted into the gloves finger. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx when the gloves finger was removed and intubation completed. Results: The pathfinder technique reduced the incidence (p<0.001), and severity (p = 0.001) of bleeding, decreased tube contamination with blood and mucus (p< 0.001), and diminished postoperative nasal pain (p=0.035). Conclusion: Our study results suggest that nasopharyngeal passage of the endotracheal tube can be facilitated by (a sterile gloves finger) acting as a pathfinder.

Acta Oto-laryngologica, 2014

Conclusion: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). Objective: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. Methods: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. Results: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.

Journal of Oral and Maxillofacial Anesthesia, 2022

TURKISH JOURNAL OF MEDICAL SCIENCES, 2013

Auris Nasus Larynx, 2008

Objective: This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS). Methods: The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients (10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times. Results: There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4 h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA-4 h), oxygen saturation value of the study group was lower than that of the control group. Conclusion: We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4 h and AS-4 h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory parameters and to give enriched oxygen by an oral catheter. #

British Journal of Anaesthesia, 1996

Regional anaesthesia is not used widely for outpatient nasal surgery. The aim of this study was to determine the role of nasociliary and infraorbital nerve block in 24 patients undergoing nasal surgery comprising: cosmetic or reconstructive surgery of the nose and surrounding soft tissue, polypal removal, turbinectomy, reduction of fractured nasal bones, small tumour resection or emergency surgery on isolated facial lacerations. Mild sedation with midazolam 0.03 mg kg 91 was used before anaesthesia. Nasociliary and infraorbital blocks were technically easy to perform, safe and provided good intraoperative conditions. Only minor complications were observed, including local bruising in eight patients and transient diplopia in one patient. No patient received general anaesthesia, but infiltration of local anaesthetic was necessary in four patients because of incomplete anaesthesia in the surgical area. Operative conditions were judged as good or excellent by surgeons in 20 of 24 patients. Twenty of 24 patients were very satisfied or satisfied with anaesthesia. Duration of surgery exceeding 60 min and excessive bleeding in the nasopharynx were the main limiting factors for the use of facial regional anaesthesia. (Br. J. Anaesth. 1996; 76: 151-153)

Violation of nasal breathing mostly related to nasal septum deformation, which is an indication to perform septoplasty. This article represents our observations about the possible cause of aesthetic complications after nasal septum resection; the technique we us for prevention of such complications, clinical cases and treatment results.