title: Reducing nasopharyngeal trauma: the urethral catheter-assisted nasotracheal intubation technique.
abstract: Nasal intubation is an advantageous approach for dental procedures performed in the hospital, ambulatory surgery center, or dental office, when possible. Although many who provide anesthesia services are familiar and comfortable with nasal intubation techniques, some are reluctant and uncomfortable because of lack of experience or fear of nasopharyngeal bleeding and trauma. It has been observed from experiences in various settings that many approaches may be adapted to the technique of achieving nasal intubation. The technique that is described in this paper suggests a minimally invasive approach that introduces the nasoendotracheal tube through the nasopharyngeal pathway to the oropharynx in an expedient manner while preserving the nasopharyngeal structures, thus lessening nasal bleeding and trauma to soft tissues. The technique uses a common urethral catheter and can be incorporated along with current intubation armamentaria. As with all techniques, some limitations to the approach have been identified and are described in this paper. Cases with limited mouth opening, neck injury, and difficult airways may necessitate alternative methods. However, the short learning curve along with the many benefits of this technique offers the anesthesia professional additional options for excellent patient care.
authors.affiliation: Department of Dental Practice, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California 94115, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Wong
authors.forename: Paul
authors.initials: P
authors.lastname: Subar
authors.forename: Heidi
authors.initials: H
authors.lastname: Witherell
authors.forename: Konstantin J
authors.initials: KJ
authors.lastname: Ovodov
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000295:instrumentation*; D000770:Anesthesia, Endotracheal / Q000295:instrumentation*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D004106:Dilatation; D004867:Equipment Design; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000033:anatomy & histology; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000187:drug effects; D009305:Nasopharynx / Q000033:anatomy & histology / Q000293:injuries*; D009666:Nose / Q000033:anatomy & histology; D012449:Safety; D013499:Surface Properties; D014546:Urinary Catheterization / Q000295:instrumentation*
chemical_list: D000779:Anesthetics, Local