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Anesth Analg 2006;103:254
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215211.59302.EE

LETTER TO THE EDITOR

Tube Design for Nasotracheal Intubation

Rajesh Mahajan, Rahul Gupta, and Anju Sharma

Department of Anaesthesia; ASCOMS; Jammu, J&K, India; drmahajanr{at}yahoo.com

To the Editor:

Various methods have been advocated to prevent trauma from nasotracheal intubation (1,2), including a recent trial by Lee et al. (3) comparing the influence of two different tip designs on nasal trauma. In this study, the authors demonstrated that softening the tube with warm saline reduced the risk of epistaxis.

However, thermosoftening a polyvinyl chloride tube can lead to its distortion and obstruction, particularly at the tube’s weakest point where the inflation lumen opens into the cuff (4–6). Thus routine use of thermosoftening cannot be recommended.

Lee et al. suggest that the Magill tip is better suited to nasotracheal intubation under direct vision. The use of a Magill tip may also ease the passage of the endotracheal tube into the trachea when a fiberoptic bronchoscope is used, as the tip of the bronchoscope can inadvertently be placed through the eye of a Murphy tip, making it impossible to advance the tube into the trachea (7,8). If retrograde nasotracheal intubation is intended using a "pulling thread technique," the use of a Murphy tip tube is necessary, so that the thread can be secured to the tip of the endotracheal tube at the Murphy eye (9,10).

REFERENCES

  1. Mahajan R, Gupta R, Sharma A. Another method to avoid trauma during nasotracheal intubation. Anesth Analg 2005;101:928–9.[Free Full Text]
  2. Elwood T, Stallions DM, Woo DW, Bradford HM. Nasotracheal intubation: a randomized trial of two methods. Anesthesiology 2002;96:51–3.[ISI][Medline]
  3. Lee JH, Kim CH, Bahk JH, Park KS. The influence of endotracheal tube tip design on nasal trauma during nasotracheal intubation: Magill-tip versus Murphy-tip. Anesth Analg 2005;101:1226–9.[Abstract/Free Full Text]
  4. Aggarwal A. Warming the tracheal tube and kinking. Can J Anaesth 2004;51:96.[Free Full Text]
  5. Lee YW, Lee TS, Chan KC, et al. Intratracheal kinking of endotracheal tube. Can J Anaesth 2000;50:311–2.
  6. Ayala JL, Coe A. Thermal softening of tracheal tube: an unprecedented hazard of the Bair Hugger Active patient warming system. Br J Anaesth 1997;79:543–5.[Abstract/Free Full Text]
  7. Asai T, Shingu K. Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope: incidence, causes and solutions. Br J Anaesth 2004;92:870–81.[Abstract/Free Full Text]
  8. Nichols KP, Zornow MH. A potential complication of fibreoptic intubation. Anesthesiology 1989;70:562–3.[ISI][Medline]
  9. Weksler N, Klein M, Weksler D, et al. Retrograde tracheal intubation: beyond fibreoptic endotracheal intubation. Acta Anesthesiol Scand 2004;48:412–6.[ISI][Medline]
  10. Mahajan R, Sandhya Y, Chari P. An alternative technique for retrograde intubation. Anaesthesia 2001;56:1207–8.[Medline]



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Tube Design for Nasotracheal Intubation
Anesth. Analg., July 1, 2006; 103(1): 254 - 254.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press