title: Ventilation via cut nasotracheal tube during general anesthesia.
abstract: Many patients with disabilities need recurrent dental treatment under general anesthesia because of high caries prevalence and the nature of dental treatment. We evaluated the use of a nasal device as a possible substitute for flexible laryngeal mask airway to reduce the risk of unexpected failure accompanying intubation; we succeeded in ventilating the lungs with a cut nasotracheal tube (CNT) with its tip placed in the pharynx. We hypothesized that this technique would be useful during dental treatment under general anesthesia and investigated its usefulness as part of a minimally invasive technique. A prospective study was designed using general anesthesia in 37 dental patients with disabilities such as intellectual impairment, autism, and cerebral palsy. CNT ventilation was compared with mask ventilation with the patient in 3 positions: the neck in flexion, horizontal position, and in extension. The effect of mouth gags was also recorded during CNT ventilation. The percentages of cases with effective ventilation were similar for the 2 techniques in the neck extension and horizontal positions (89.2-97.3%). However, CNT ventilation was significantly more effective than mask ventilation in the neck flexion position (94.6 vs 45.9%; P < .0001). Mouth gags slightly reduced the rate of effective ventilation in the neck flexion position. Most dental treatments involving minor oral surgeries were performed using mouth gags during CNT ventilation. CNT ventilation was shown to be superior to mask ventilation and is useful during dental treatment under general anesthesia.
authors.affiliation: Department of Dentistry, Morinomiya Hospital, Osaka City, Japan. asahi@omichikai.or.jp
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Asahi
authors.forename: Shiro
authors.initials: S
authors.lastname: Omichi
authors.forename: Seita
authors.initials: S
authors.lastname: Adachi
authors.forename: Hajime
authors.initials: H
authors.lastname: Kagamiuchi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kotani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D001321:Autistic Disorder; D002547:Cerebral Palsy; D002648:Child; D003730:Dental Care for Persons with Disabilities; D005260:Female; D006801:Humans; D008607:Intellectual Disability; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009333:Neck / Q000033:anatomy & histology; D019647:Oral Surgical Procedures / Q000379:methods; D019989:Persons with Intellectual Disabilities; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D055815:Young Adult