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LETTER TO EDITOR
Year : 2017  |  Volume : 11  |  Issue : 3  |  Page : 367-368

Use of stylet in armored tube for nasotracheal intubation: Why not??


Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Pooja Bihani
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
Priyanka Sethi
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.206800

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Date of Web Publication29-Jun-2017
 


How to cite this article:
Bihani P, Bhatia PK, Mohhammad S, Sethi P. Use of stylet in armored tube for nasotracheal intubation: Why not??. Saudi J Anaesth 2017;11:367-8

How to cite this URL:
Bihani P, Bhatia PK, Mohhammad S, Sethi P. Use of stylet in armored tube for nasotracheal intubation: Why not??. Saudi J Anaesth [serial online] 2017 [cited 2017 Sep 20];11:367-8. Available from: http://www.saudija.org/text.asp?2017/11/3/367/206800



Sir,

For nasotracheal intubation (NTI), armored tubes allow head and neck manipulation without risk of kinking of the tube during surgery. Due to its inherent flexibility, intubation with an armored tube has its own sets of difficulties.[1] These tubes tend to move along the posterior pharyngeal wall toward esophagus rather than toward laryngeal inlet or it may pass through vocal cords but may not be negotiated into subglottic region. Magill forceps is almost always required to navigate the tip of tube into vocal cords which may injure tube cuff or the oropharyngeal mucosa.

To overcome these issues, we are routinely performing NTI with aid of malleable stylet. After introducing stylet, the tube-stylet assembly is molded to have a gentle bend in middle of the tube. Care is taken that tip of stylet remains within 2–3 mm of the end of the tube. Tube-stylet assembly is advanced through more patent nostril with gentle pressure till nasopharynx. Although Magill forceps may be required to direct tip toward glottis but manipulation of tip becomes easier by holding the tube proximal to cuff decreasing the likelihood of injury to cuff and surrounding structures. It is especially a valuable technique in subjects with Cormack-Lehane Grade III or IV in which directing the tube toward larynx would be difficult.

Several mechanical devices have been described to aid NTI including suction catheter, nasogastric tubes, and gum elastic bougie.[2],[3],[4] Although stylet had also been reported to facilitate blind NTI, it is not used routinely because of anticipated risk of trauma, bleeding, creation of false passage, and injury to adenoid tissue.[5] However, these complications can occur with the armored tube without stylet also if undue force is applied. The use of stylet is not associated with increased incidences of trauma or bleeding in our routine practice. Therefore, use of stylet in armored tracheal tube can be considered as an effective tool for NTI.

Yours sincerely

Pooja Bihani,

Senior Resident, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia 2003;58:249-56.  Back to cited text no. 1
    
2.
Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth 2006;53:295-8.  Back to cited text no. 2
    
3.
Sugiura N, Yamada M, Kainuma M, Miyake T. The use of a nasogastric tube as an aid in blind nasotracheal intubation: A postscript. Anesthesiology 1997;87:449.  Back to cited text no. 3
    
4.
Arisaka H, Sakuraba S, Furuya M, Higuchi K, Yui H, Kiyama S, et al. Application of gum elastic bougie to nasal intubation. Anesth Prog 2010;57:112-3.  Back to cited text no. 4
    
5.
Berry FA. The use of stylet in blind nasotracheal intubation. Anesthesiology 1984;61:469-71.  Back to cited text no. 5
    




 

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