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LETTER TO THE EDITOR

Smaller Is Better Through the Nose

Department of Military Anaesthesia and Critical Care; Royal Centre for Defence Medicine; Vincent Drive, Edgbaston; Birmingham, United Kingdom; j.l.tong{at}bham.ac.uk

To the Editor:

Sugiyama et al.1 describe a successful awake nasotracheal intubation using the Styletscope as a rescue device in a patient with an anticipated difficult airway and intubation.

It is standard practice to select an endotracheal tube (ETT) with a smaller internal diameter for an intubation via the nasal route than via the mouth. Smaller ETTs cause less nasal trauma and epistaxis, which facilitate the endoscopic view during a difficult fiberoptic intubation.2 Previous surgery and radiotherapy are known to cause tissue scarring and stiffness, which can make fiberoptic intubation difficult. In these patients, it is also advisable to use a smaller ETT than normal. It has also been shown that greater the space between the ETT and the fiberscope, the higher the likelihood of encountering difficulty while advancing the ETT over the fiberscope.3 Consequently, the difficulties experienced by the authors may have been less had they used a nasal ETT smaller than size 8 mm.

They describe difficulty while attempting to insert both the tip of the fiberscope and the ETT into the trachea because they headed posteriorly. This point requires clarification since usually the fiberscope is advanced into the trachea allowing visualization of the carina before attempting to advance or railroad the ETT over the fiberscope and through the glottis.

REFERENCES

1. Sugiyama K, Okushima K. Difficult intubation in a patient without a mandibular body. Anesth Analg 2008;106:677–8[Free Full Text]
2. Ahmed-Nusrath A, Tong JL, Smith JE. Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes. Br J Anaesth 2008;100:269–74[Abstract/Free Full Text]
3. 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]

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				F. S. Xue, X. Liao, Y. M. Zhang, J. E. Smith, and J. L. Tong Pathway of the tracheal tube and complications of nasal intubation Br. J. Anaesth., February 1, 2009; 102(2): 282 - 283. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tong, J. L. Search for Related Content PubMed PubMed Citation Articles by Tong, J. L.