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BJA Advance Access published online on April 15, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei146
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted March 18, 2005

Case Report

Nasotracheal intubation: look before you leap

T. Piepho 1*, A. Thierbach 1, and C. Werner 1

1 Department of Anesthesiology, Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany

* To whom correspondence should be addressed.
T. Piepho, E-mail: Tim.Piepho{at}gmx.de


  Abstract

Nasotracheal intubation is frequently used for airway management during maxillofacial surgery. Complications such as haemorrhage occur more frequently with this route of intubation than with the orotracheal route. This case report describes a male patient aged 51 yr who developed severe epistaxis after the tube had passed the nares. As an additional complication laryngoscopy and endotracheal intubation failed because of difficult airway (Cormack-Lehane grade 4). Attempts using an intubating laryngeal mask airway and a Bonfils intubating fibrescope did not succeed. The airway was finally managed by cricothyroidotomy. A modified sequence of nasotracheal intubation is proposed to avoid similar life-threatening complications.

Keywords: airway; equipment, tubes, tracheal; ventilation, failure.
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E-letters:

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Nasal intubation: An alternative approach
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British Journal of Anaesthesia, 5 Jun 2005 [Full text]
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