title: Blind Nasal Intubation Revisited: No Longer a Blind Technique?
abstract: BACKGROUND
  Advancements in airway management have made the practice of blind nasal intubation obsolete. We report on successful blind nasal intubation performed with the help of capnography and real-time ultrasonography in two patients with tempormandibular joint ankylosis.
  
  
  METHODS
  Blind nasal intubation was performed in a 12-year-old patient and a 17-year old patient under general anesthesia with spontaneous respiration. Capnography was used as an aid during insertion and dynamic ultrasonography was performed to guide and confirm proper tracheal tube placement. Use of capnography helps in following the correct path toward the glottic opening, with quick detection of any obstruction, and with confirmation of final placement of the tracheal tube. Ultrasonography aids with entry into the glottis and with identifying the correct placement. We recommend the use of this modified blind nasal intubation in patients with limited mouth opening when equipment, such as a fiberoptic scope, is not available or is nonfunctional in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Adapting this technique will add to the armamentarium available for airway management in emergency medicine, particularly in maxillofacial injuries with limited mouth opening.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, India.
authors.forename: Prakash K
authors.initials: PK
authors.lastname: Dubey
authors.affiliation: Manipal College of Dental Sciences, Mangalore, India.
authors.forename: Preksha
authors.initials: P
authors.lastname: Dubey
authors.affiliation: Department of Radiology, Indira Gandhi Institute of Medical Sciences, Patna, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, India.
authors.forename: Gautam
authors.initials: G
authors.lastname: Bhardwaj
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, All India Institute of Medical Sciences, Patna, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000379:methods / Q000592:standards*; D000844:Ankylosis / Q000150:complications; D019296:Capnography / Q000379:methods*; D002648:Child; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D008297:Male; D019647:Oral Surgical Procedures; D013705:Temporomandibular Joint Disorders / Q000150:complications; D014463:Ultrasonography / Q000379:methods*
keywords: blind nasal; capnography; intubation; ultrasonography