title: Transnasal jet ventilation is a useful adjunct to teach fibreoptic intubation: a preliminary report.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Transnasal jet ventilation-assisted FOI is a useful method to train residents in FOI while maximizing patient comfort and safety.
authors.affiliation: Departments of Anesthesiology. and Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. james.boyce@ccc.uab.edu
authors.forename: James R
authors.initials: JR
authors.lastname: Boyce
authors.forename: Peter D
authors.initials: PD
authors.lastname: Waite
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Louis
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ness
mesh_terms: D000776:Anesthesiology / Q000193:education*; D001999:Bronchoscopy / Q000379:methods*; D005336:Fiber Optic Technology; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D009305:Nasopharynx; D011175:Positive-Pressure Respiration / Q000379:methods