Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Protecting the tracheal tube cuff: a novel solution

  • Abel, Adam (Department of Dentistry, Oral and Maxillofacial Surgery, New York Presbyterian Hospital - Weill Cornell Medical Center) ;
  • Behrman, David A. (Department of Dentistry, Oral and Maxillofacial Surgery, New York Presbyterian Hospital - Weill Cornell Medical Center) ;
  • Samuels, Jon D. (Department of Anesthesiology, New York Presbyterian Hospital - Weill Cornell Medical Center)
  • Received : 2021.02.08
  • Accepted : 2021.03.08
  • Published : 2021.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

We describe the successful insertion of a nasotracheal tube following repeated cuff rupture. The patient was a 55-year-old woman with a history of nasal trauma and multiple rhinoplasties, who underwent elective Lefort I osteotomy and bilateral sagittal split osteotomy for correction of skeletal facial deformity. During fiberoptic bronchoscope-guided nasal intubation after the induction of general anesthesia, the tracheal tube repeatedly ruptured in both nares, despite extensive preparation of the nasal airways. We covered the cuff with a one-inch tape, intubated to the level of the oropharynx, pulled the tracheal tube out through the mouth, and removed the tape. The tracheal tube was then backed out to the level of the uvula, and was successfully advanced.

Keywords

References

  1. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care 2014; 59: 865-80. https://doi.org/10.4187/respcare.03012
  2. Prasanna D, Bhat S. Nasotracheal intubation: an overview. J Maxillofac Oral Surg 2014; 13: 366-72. https://doi.org/10.1007/s12663-013-0516-5
  3. Smith JE, Reid AP. Asymptomatic intranasal abnormalities influencing the choice of nostril for nasotracheal intubation. Br J Anaesth 1999; 83: 882-6. https://doi.org/10.1093/bja/83.6.882
  4. Thota RS, Doctor JR. Evaluation of paranasal sinuses on available computed tomography in head and neck cancer patients: an assessment tool for nasotracheal intubation. Indian J Anaesth 2016; 60: 960-1. https://doi.org/10.4103/0019-5049.195502
  5. Mittal AK, Kulkarni A. A simple method to protect tracheal cuff of double lumen tube from damage during intubation. J Anaesthesiol Clin Pharmacol 2012; 28: 417-8. https://doi.org/10.4103/0970-9185.98382
  6. Fortier G, St-Onge S, Bussières J. Two other simple methods to protect the tracheal cuff of a double-lumen tube. Anesth Analg 1999; 89: 1064. https://doi.org/10.1213/00000539-199910000-00047
  7. Erb J. A less difficult method to protect the tracheal cuff of a double-lumen tube. Anesthesia & Analgesia 1998; 87: 1217. https://doi.org/10.1097/00000539-199811000-00065
  8. Sahu S, Sahoo A, Patel GP, Pant KC. Incidental tracheal cuff rupture during placement of double-lumen, what to do? Int J Crit Illn Inj Sci 2013; 3: 92-3. https://doi.org/10.4103/2229-5151.109432
  9. Kaloria N, Goyal S, Sethi P, Bhatia P. Repeated cuff rupture with nasal intubation: what we learn!!! Indian J Anaesth 2019; 63: 680-2. https://doi.org/10.4103/ija.IJA_275_19
  10. Hsu CT, Shih CK, Chau SW, Tseng KY, Chen MK, Cheng KI. Modified glove fingers as an aid for safely navigating endotracheal tube through the nasal cavity and nasopharynx in difficult nasotracheal intubation. Acta Anaesthesiol Taiwan 2011; 49: 119-21. https://doi.org/10.1016/j.aat.2011.08.001
  11. Mahajan R, Gupta R. Another method to avoid trauma during nasotracheal intubation. Anesth Analg 2005; 101: 928-9. https://doi.org/10.1213/01.ANE.0000173679.77321.A8
  12. Barras JP, Bigler P, Czerniak A. A rare complication of the use of a finger cot to protect the cuff of a tracheal tube during nasotracheal intubation. Intensive Care Med 1993; 19: 174-5. https://doi.org/10.1007/BF01720536