This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boyce, J. R. Articles by Ness, T. J. Search for Related Content PubMed PubMed Citation Articles by Boyce, J. R. Articles by Ness, T. J.

Transnasal jet ventilation is a useful adjunct to teach fibreoptic intubation: a preliminary report

[La ventilation en jet transnasale est un complément avantageux à l’enseignement de l’intubation fibroscopique : un rapport préliminaire]

James R. Boyce, MD^*, Peter D. Waite, DDS MD, Patrick J. Louis, DDS MD and Timothy J. Ness, MD^*

^* From the Departments of Anesthesiology
and Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Address correspondence to: Dr. James R. Boyce, Department of Anesthesiology, JT 845Q University of Alabama at Birmingham, 619 South 19th Street, Birmingham, AL 35294-6810, USA. Phone: 205-934-6948; Fax: 205-975-3080; E-mail: james.boyce{at}ccc.uab.edu

Purpose: Fibreoptic intubation (FOI) has become an essential technique in the anesthetic management of patients with difficult airways. Unfortunately, residents may graduate from anesthesiology training programs with insufficient skills in FOI. To enhance resident proficiency at FOI without compromising patient comfort or safety, the technique of transnasal jet ventilation-assisted FOI was developed. This report describes our initial experience with this technique.

Methods: Sixty-four patients scheduled for oromaxillofacial surgery under nasal endotracheal anesthesia were recruited. Twenty-eight residents at all levels of training performed FOI through the patient’s right nostril after the induction of general anesthesia and neuromuscular blockade. Oxygenation and ventilation were maintained by a faculty anesthesiologist using a Sanders device to deliver a jet of oxygen through a nasal trumpet placed in the patient’s left nostril. The time from induction until completion of the FOI was recorded. Residents were subsequently queried about the educational benefit of the technique using a standardized questionnaire.

Results: All residents were able to successfully intubate all patients in this study. Thirteen residents successfully performed intubations on three or more occasions with 70% performing the technique faster on the third trial than on the first. No evidence of hypoxemia, gastric distension, pneumothorax, hemodynamic instability or recall was observed. All respondents to the questionnaire reported that the technique was useful as an educational tool and recommended its use with other residents.

Conclusion: Transnasal jet ventilation-assisted FOI is a useful method to train residents in FOI while maximizing patient comfort and safety.