Nasopharyngeal Trumpet Serves as Direct Conduit in Fiberoptic Intubation

Is there a simple approach to facilitating fiberoptic intubation in the difficult airway?

Background: Although fiberoptic intubation is one of the more successful and frequently utilized methods to access the difficult airway, it comes with challenges such as the presence of blood and secretions in the nasal and pharyngeal airways, edema from transoral attempts or anatomic distortion from radiation and prior surgery, all of which obscure the endoscopic view.

Study design: Case study.

Setting: Department of Anesthesiology, Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston.

Synopsis: Of 10 patients who underwent transnasal fiberoptic intubation for the perioperative anesthetic management of the airway, a representative case is described. A 36 French nasopharyngeal trumpet (NT) was longitudinally incised along the entire length with a scalpel, lubricated with 2 percent lidocaine HC1 jelly and utilized for fiberoptic guidance. The nose was treated with phenylephrine HC1 0.5 percent prior to a traumatic placement of the largest NT airway tolerated, which then facilitated guidance of the endoscope and endotracheal tube into the larynx for successful intubation. The advantages of using a nasopharyngeal trumpet included the ubiquitous availability of the NT, minimal cost, ease of use and applicability and the universal comfort of anesthesiologists with the appliance and with the transnasal fiberoptic intubation approach. Rather than a more expensive, commercially available oral airway, the ubiquitously available nasopharyngeal airway can be easily modified and used to place the endotracheal tube transnasally, the authors said. Potential weaknesses of this approach include risk for advancing the proximal end of the NT beyond the nasal sill into the nares and the inability of this technique to address intraglottic and subglottic disease.

Bottom line: The nasopharyngeal trumpet can facilitate transnasal fiberoptic intubation in the difficult airway.

Citation: Heir JS, Kupferman ME. A simple approach to facilitating fiberoptic intubation in the difficult airway. Laryngoscope. 2011;121(2):310-312.

—Reviewed by Sue Pondrom