title: Nasotracheal intubation depth in paediatric patients.
abstract: BACKGROUND
  The aim of this study was to compare intubation depth using the Microcuff paediatric endotracheal tube (PET) placed with the intubation depth mark between the vocal cords with that of different published formulae/recommendations for nasotracheal intubation depth in children.
  
  
  METHODS
  Children aged from birth to 10 yr undergoing elective surgery with nasotracheal intubation were included. Tracheal tubes were adjusted according to the intubation depth mark between the vocal cords using direct laryngoscopy. Nasal intubation depth was recorded and the distance 'tube tip to carina' was measured endoscopically. Based on the recorded nasal intubation depth and measured distance 'tube tip to carina', the position of tube tip and cuff was calculated according to six published formulae/recommendations.
  
  
  RESULTS
  Seventy-six children were studied. For the Microcuff PET, the median tube tip advancement within the trachea was 52.9% (41.1-73.8%) of tracheal length. The shortest distance from the 'tube tip to carina' was 15 mm for a 3.5 mm internal diameter tube. If the six published formulae/recommendations had been used, this would have resulted in endobronchial tube placement in up to 9.1% of cases, and the tube tip would have been placed above the glottis in up to 2.6% of cases. The upper border of the cuff would have been placed in the subglottic area in up to 42.1% of cases and in a supraglottic position in up to 63.2% of cases.
  
  
  CONCLUSIONS
  This study indicates that nasal intubation with the intubation depth mark placed between the vocal cords was superior to formula-based nasotracheal tube positioning. The latter would result in a high rate of endobronchial intubations, excessively high cuff positions and even tracheal extubations.
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Kemper
authors.affiliation: Institute of Anaesthesia and Intensive Care Medicine, Kantonsspital, Frauenfeld, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Dullenkopf
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
authors.forename: A R
authors.initials: AR
authors.lastname: Schmidt
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Gerber
authors.affiliation: Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland markus.weiss@kispi.uzh.ch.
authors.forename: M
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D014132:Trachea / Q000033:anatomy & histology* / Q000254:growth & development; D014827:Vocal Cords / Q000033:anatomy & histology / Q000254:growth & development
keywords: airway; children; complications, intubation nasotracheal; intubation; tracheal tube