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Blind intubation using the Endotrol tube and a light wand

Osaka, Japan.

To the Editor:

The Endotrol tracheal tube (Mallinckrodt, Athlone, Ireland) is useful for blind nasotracheal intubation, since the curve of the tube can be controlled by a wire hook.^1,2 We suggest that the use of a light wand (Trachlight [Laerdal Medical, New York, USA]) adds to the usefulness of the Endotrol tube.

A 25-yr-old woman had a fractured jaw a few months ago and was scheduled for reconstruction of the jaw. Preoperatively, the mouth opening was restricted to two-fingers width. General anesthesia was induced, and after adequate ventilation was confirmed vecuronium was injected. An Endotrol tube was inserted into the nose and oral laryngoscopy was attempted. Since the glottis could not be seen, blind tracheal intubation was attempted. However, location of the glottis was difficult due to the lack of spontaneous breathing, and intubation failed after three attempts.

Trachlight-aided blind nasotracheal intubation was then attempted while a fibreoptic bronchoscope was being prepared. After the inner metal stylet has been removed from the Trachlight, the wand was inserted into the Endotrol tube. By advancing the tube, illumination was seen in the side of the neck. This time, the tube position could easily be adjusted to the centre by rotating the tube and pulling the hook. The tube was further advanced, the wand was removed and the correct position was confirmed. The time for tracheal intubation was less than 30 sec.

References

1 Hooker EA, Hagan S, Coleman R, Heine MF, Greenwood P. Directional-tip endotracheal tubes for blind nasotracheal intubation. Acad Emerg Med 1996; 3: 586–9.[Medline]

2 Asai T. Endotrol tube for blind nasotracheal intubation (Letter). Anaesthesia 1996; 51: 507.

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