What is nasotracheal intubation?
Intubation is a bedside procedure in which a tube is inserted either into your nose or mouth to help you breathe better. It is a life-saving procedure done in emergency situations.
Intubation through the mouth is known as orotracheal intubation and through the nose is known as nasotracheal intubation.
When you are unconscious, your breathing is affected. Your oxygen levels may fall, which can be dangerous. At such times, external breathing support is provided with the help of a machine known as a ventilator. The ventilator acts as breathing support by enabling you to breathe through intubation.
When is nasotracheal intubation used?
Nasotracheal intubation is used in various conditions such as:
What makes you unfit for nasotracheal intubation?
Doctors may not plan nasotracheal intubation on you if you have
- A previous history of old or new skull fractures
- Bleeding disorders
- Coagulopathy (clotting disorders)
- Apnea (a condition in which breathing stops due to obstruction in the upper respiratory system)
- Large nasal polyps (fleshy growths in the nose)
- Suspected nasal foreign bodies
- Recent nasal surgery
- Infection in your upper neck
- History of frequent episodes of epistaxis
- Prosthetic (artificial) heart valves
How is nasotracheal intubation performed?
- Nasotracheal intubation is generally performed by an anesthetist.
- You will be given general anesthesia, which makes you numb and sleeps throughout the procedure. If you are unfit for anesthesia, you will be given sedatives to make you sleep.
- The anesthetist will first check if you are fit to be put on a ventilator. This is done by inflating a balloon-like structure known as a bag-mask into your nose through a lubricated tube (endotracheal tube).
- You might be given oxygen from the bag-mask to increase the levels of oxygen in your blood before the intubation.
- Certain medicines will be sprayed inside your nose to numb it and prevent bleeding.
- To prevent bleeding in your nose, a medicine like epinephrine or adrenaline will be sprayed inside your nose.
- The anesthetist will check if there is any obstruction in your nasal cavity by inserting a small tube-like structure, a nasal trumpet, in your nose.
- After checking the nasal cavity, the nasal trumpet will be removed, and an endotracheal tube will be inserted into one of your nostrils.
- A tube-like structure known as a laryngoscope will be inserted into the oral cavity to visualize your local cords (larynx).
- The laryngoscope will be used as a guide to correctly insert the endotracheal tube through the vocal cords into your windpipe. The windpipe is the part of your airway that is connected to your lung.
- Your doctor may still need to check if the tube has been placed correctly. To confirm this, they will listen to your breathing with a stethoscope.
- The endotracheal tube will then be connected to the ventilator.
What are the complications of nasotracheal intubation?
The complications that can arise while performing the nasotracheal intubation include:
- Damage to nasal cavity: Your nose might bleed (epistaxis) when it is accidentally damaged during intubation.
- Damage to teeth: Teeth may get injured during laryngoscopy.
- Vocal cord damage: You may experience a sore throat or difficulty speaking due to vocal cord damage.
- Infection of trachea or lungs: You may find it hard to breathe due to infection of the trachea or lungs.
- Pneumothorax: This complication involves the leaking of air in the space between the lungs and the chest wall.
- Obstruction of the endotracheal tube: Foreign bodies, polyps, or blood clots might partially or completely obstruct the endotracheal tube.
- Aspiration: Whatever you eat may get pulled into the lung.
Nasotracheal Intubation. Available at: https://emedicine.medscape.com/article/1663655-overview Holzapfel L. Nasal vs oral intubation. Minerva Anestesiol. 2003;69(5):348-352. Available at: https://pubmed.ncbi.nlm.nih.gov/12768165/
Top What Is Nasotracheal Intubation Related Articles
Anectine (succinylcholine chloride)Anectine is a prescription medicine used to treat the symptoms of Neuromuscular Blockade. Anectine may be used alone or with other medications. Serious side effects include cardiac arrest, life threatening elevation in body temperature, abnormal heart rhythms, fast or slow heart rate, high or low blood pressure, high blood potassium, prolonged slow breathing, increased eye pressure, muscle twitching, jaw rigidity, postoperative muscle pain, breakdown of muscle tissue (rhabdomyolysis), excessive salivation, and rash.
Bridion (sugammadex)Bridion (sugammadex) Injection is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults undergoing surgery. Common side effects of Bridion include vomiting, pain, nausea, low blood pressure (hypotension), headache, abdominal pain, gas, dry mouth, fever, chills, dizziness, mouth or throat pain, cough, pain in extremities, muscle pain, insomnia, anxiety, reduced sense of touch, and others.
Sleep Disorders: Foods That Help Sleep or Keep You AwakeNeed more shut-eye? Your late-night cravings could be keeping you from a good night’s sleep. Should you drink green tea before bed? Learn about the snacks that raise melatonin, your sleep hormone, through tryptophan, and find out why whole-grain and high-protein dinners might help you sleep better.
lidocaine topicalLidocaine topical is used as a local anesthetic to numb and lubricate various parts of the body for medical procedures. It is also used to delay premature ejaculation and relieve minor skin irritations (sunburn, insect bites, minor burns, cuts, and scrapes). Side effects of lidocaine topical include allergic skin reactions, slow heartbeat (bradycardia), low blood pressure (hypotension), cardiovascular collapse, cardiac arrest, drowsiness, light-headedness, dizziness, and others. Lidocaine topical may be used in pregnancy, labor, and delivery, and must be used with caution in nursing women.
What Are Lighted Stylet-Assisted Tracheal Intubation Devices?Intubation or endotracheal intubation is a medical procedure in which a tube (endotracheal tube) is placed into the windpipe (trachea) through the mouth or nose. In most emergencies, endotracheal intubation is performed through the mouth. The main indication is in patients with a difficult airway for whom a direct laryngoscopy (a procedure for visualization of the vocal cords) has failed, for example, a trauma patient with bleeding in the area behind the mouth (oropharynx).
Sleep DisordersA number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. The National Institutes of Health recommend about 7-9 hours of sleep each night for older, school-aged children, teens, and most average adults; 10-12 for preschool-aged children; and 16-18 hours for newborns. There are two stages of sleep: 1) REM sleep (rapid-eye movement), and 2) NREM sleep (non-rapid-eye movement).
Sleep Disorders in Children and TeenagersSleep needs in children and teenagers depend on the age of the child. Sleep disorders in children such as: sleep apnea, parasomnias, confusional arousals, night terrors, nightmares, narcolepsy, and sleepwalking which can affect a child's or teen's sleep. Healthy sleep habits and good sleep hygiene can help your infant, toddler, preschooler, tween, or teenager get a good night's sleep.
Sleep ApneaSleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Dos and Don'ts After a Bad Night's SleepYou didn’t sleep last night. Now what? Find out from WebMD what to do to make the best of the day and night ahead.
Sleep Disorders: Insomnia, Sleep Apnea, and MoreLearn about the different types of sleep/wake disorders such as insomnia, narcolepsy, and sleep apnea. Explore the symptoms, causes, tests and treatments of sleep disorders.
Sleep Related Breathing DisordersSleep-related breathing disorders are characterized by disruptions of normal breathing patterns that only occur during sleep. Snoring and sleep apnea are the most common sleep-related breathing disorders.
succinylcholineSuccinylcholine is a skeletal muscle relaxant used for medical procedures done under general anesthesia, including tracheal intubation, mechanical ventilation, and surgeries. Common side effects of succinylcholine include postoperative muscle pain, jaw rigidity, muscle twitch (fasciculation), respiratory depression, cessation of breathing (apnea), low or high blood pressure (hypotension or hypertension), irregular heart rhythms (cardiac arrhythmias), slow or rapid heartbeat (bradycardia or tachycardia), cardiac arrest, increase in intraocular pressure (IOP), high blood potassium levels (hyperkalemia), severe life-threatening drug reaction with excessively high temperature (malignant hyperthermia), salivary gland enlargement, excessive salivation, rash, hypersensitivity reactions, and others.
What Are Video Laryngoscopy and Fiberoptic-Assisted Tracheal Intubation?Tracheal intubation, also called intubation, involves placing a flexible plastic tube (endotracheal [ET] tube) into the trachea (windpipe) to maintain an open airway, ventilate the lungs, or administer certain drugs. Video laryngoscopy is a form of indirect laryngoscopy in which the physician does not directly inspect the larynx. Fiberoptic intubation involves inserting an ET tube over the shaft of a flexible fiberoptic scope for visualization. Video laryngoscopy and fiberoptic laryngoscope aid in tracheal intubation.
What Is Bag Valve Mask Ventilation (BVM) Used For?Bag-valve-mask (BVM) or the Ambu bag is a self-inflating bag used to provide ventilation to the person not breathing normally. BVM ventilation is a critical skill for emergency providers. BVM ventilation is a technique that restores breathing in patients who are not spontaneously breathing. BVM ventilation is indicated in the respiratory (lung) failure, failed intubation (insertion of an artificial ventilation tube into the trachea), patients undergoing anesthesia for elective surgery, and apnea (slowed or stopped breathing).
When Should a Tracheostomy Tube Be Changed?A tracheostomy is an opening that surgeons make through the front of the neck and into the windpipe (trachea). The tracheostomy tube is placed into the opening to keep it open for breathing when the usual route for breathing is somehow blocked or reduced. When health problems require long-term use of a machine (ventilator) to help breathe, a tracheostomy is often needed. In rare cases, an emergency tracheostomy is performed when the airway is suddenly blocked, such as after a severe injury to the face or neck.
Why Would A Child Need A Tracheostomy?A tracheostomy, a procedure to cut a hole in the throat to clear an airway to the lungs, is used to insert a tube into the trachea to provide assisted ventilation to children who are unable to breathe, or have difficulty breathing on their own.