title: Nasotracheal intubation: a simple and effective technique to reduce nasopharyngeal trauma and tube contamination.
abstract: Our hypothesis was that nasopharyngeal passage of an endotracheal tube can be facilitated by a nasopharyngeal airway (Wendl tube) acting as a "pathfinder." Accordingly, 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, a Wendl tube (28 Ch) was inserted into the more patent nostril. In the control group (n = 30), the Wendl tube was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter, 7.0 mm). In the intervention group (n = 30), the Wendl tube was kept in position and only its adjustable flange was removed. Then, we inserted the tip of the endotracheal tube into the trailing end of the Wendl tube. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx guided by the Wendl tube. After the endotracheal tube was positioned in the oropharynx, the Wendl tube was removed and intubation completed. Six hours after surgery, we determined the patients' nasal pain. 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 = 0.036).
  
  
  CONCLUSIONS
  Nasopharyngeal passage of an endotracheal tube can be facilitated by a flexible Wendl tube (nasopharyngeal airway) covering and guiding the rigid tube tip. This technique is helpful in reducing the incidence and severity of nosebleeds and in minimizing contamination of the tip of the endotracheal tube with blood and mucus.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Münster, Albert-Schweitzer-Strasse 31, 48149 Münster, Germany. d.enk@t-online.de
authors.forename: Dietmar
authors.initials: D
authors.lastname: Enk
authors.forename: Anne M
authors.initials: AM
authors.lastname: Palmes
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation / Q000295:instrumentation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000293:injuries*; D010614:Pharynx / Q000293:injuries*