title: A comparison of a flexometallic tracheal tube with the intubating laryngeal mask tracheal tube for nasotracheal fibreoptic intubation using the two-scope technique.
abstract: We compared the incidence and site of impingement of a flexometallic tracheal tube with those of the re-usable intubating laryngeal mask (ILMA) tube in 60 anaesthetised patients undergoing nasotracheal fibreoptic intubation for oral surgery. A two-scope technique was used, observing the site of impingement with one scope whilst intubating with the other. The tubes were 6.0-mm in females and 6.5-mm in males. Impingement occurred with 10 (33%) flexometallic and 2 (7%) ILMA tubes (p < 0.032). In all but one case, the impingement was posterior to the right arytenoid cartilage. When impingement was observed, a single disempaction with a 90 degrees anticlockwise rotational manoeuvre overcame impingement in every case except one, allowing successful intubation. We conclude that the incidence of impingement of the tracheal tube, and therefore of potential laryngeal trauma from nasotracheal fibreoptic intubation, is significantly greater with the flexometallic tube than with the ILMA tube.
authors.affiliation: Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Rai
authors.forename: S H
authors.initials: SH
authors.lastname: Scott
authors.forename: A G
authors.initials: AG
authors.lastname: Marfin
authors.forename: M T
authors.initials: MT
authors.lastname: Popat
authors.forename: J J
authors.initials: JJ
authors.lastname: Pandit
mesh_terms: D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D017214:Laryngeal Masks / Q000009:adverse effects; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D019647:Oral Surgical Procedures; D055815:Young Adult