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Effective nasotracheal intubation using a modified transillumination technique

[Intubation nasotrachéale efficace grâce à une technique modifiée de transillumination]

From the Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza, Rome, Italy.

Address correspondence to: Dr. Paolo Tordiglione, Department of Anesthesiology and Intensive Care, University of Rome "La Sapienza", 837 Via Cassia, 00189 Rome, Italy. Phone: +39-0633252209; Fax: +39-064461967; E-mail: tordiglione{at}rocketmail.com

Purpose: Difficult intubation is a major problem in anesthesia. In case of limited mouth opening only a few intubating devices are available. Our study was designed to evaluate the effectiveness and safety of a modified transillumination technique for nasotracheal intubation (NTI).

Methods: One hundred twenty-three patients needing NTI were studied, 76 in group A: NTI with no expected intubation difficulty; and 47 in group B: limited mouth opening (<20 mm). All intubations were performed with the Trachlight^TM. Patients in group A were under general anesthesia while deep sedation (maintaining spontaneous breathing) was used in patients in group B. The standard transillumination technique was modified by keeping the metallic stylet in place and personalizing the length and the angle of the short arm of the J shaped endotracheal tube-transillumination lightwand (ETT-TL) assembly.

Results: The overall rate of success was 98.4% and 92.6% of intubations were successful on the first attempt. The average duration of intubation was 28 sec ± 15 sec. Success rate and duration of intubation were similar in both groups.

Conclusion: Modification of the technique facilitated transillumination and placement of the ETT. The simplicity and high success rate of NTI by transillumination with the TL suggest our modified technique is a valuable alternative for NTI in patients with difficult airway.

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