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Correspondence  |   May 2000
Use of Esophageal Stethoscope as an Introducer during Nasotracheal Intubation
Author Notes
  • Seoul National University College of Medicine
  • Assistant Professor
  • Department of Anesthesiology
  • bahkjh@plaza.snu.ac.kr
  • Fellow in Anesthesiology
  • Assistant Professor
  • Department of Anesthesiology
  • Seoul National University College of Medicine
  • Seoul National University Hospital
  • Seoul 110-744, Korea
Article Information
Correspondence
Correspondence   |   May 2000
Use of Esophageal Stethoscope as an Introducer during Nasotracheal Intubation
Anesthesiology 5 2000, Vol.92, 1503. doi:
Anesthesiology 5 2000, Vol.92, 1503. doi:
To the Editor:—
We read with interest the case report by Williams et al  . 1 of an accidental middle turbinectomy during nasotracheal intubation. Though the authors stated it as being the first case, there have been some earlier reports on middle turbinectomy. 2–4 
Prewarming of endotracheal tube (ETT) to soften, lubricating of the ETT, and using a vasoconstrictor have been recommended to reduce trauma during nasotracheal intubation. Nonetheless, severe nasal traumas have been reported. 1–8 Others have described a technique to facilitate the atraumatic passage of nasotracheal tubes, such as an intraluminal balloon. 9 However, this is not widely available. An alternative that might be useful is the esophageal stethoscope–ETT combination, which can be assembled at bedside by using readily available anesthetic materials. In addition, the esophageal stethoscope can be used alone after it used as a guide.
A pediatric esophageal stethoscope (17 French: Mallinckrodt Medical, Athlone, Ireland) is positioned with its tip protruding about 2 cm out of the distal end of an ETT (internal diameter: 7.0 mm Mallinckrodt Medical). The proximal tip of esophageal stethoscope is connected to a syringe via a 3-way stopcock. Injecting about 6 ml of air and locking the 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of the ETT (fig. 1).
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
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If nasal trauma occurs during the advancement of ETT, this method would be effective in preventing the introduction of a torn part of nasal tissue into the trachea 5 or the obstruction of ETT by it, 7 because the end of ETT is obturated with esophageal stethoscope. For fiberscope-guided intubation, this method may prevent visual obstruction from mucus plug 10 or bleeding. During direct laryngoscopy, its distal tip provides a portion to grasp with intubating forceps, preventing ETT cuff damage.
When the esophageal stethoscope is inflated, the tip has a tendency to bend to the bevel side, which seems to be the drawback of this method. However, you can take advantage of the bent tip and direct the ETT away from the tubinates, which can avoid the possibility of turbinate trauma.
References
Williams AR, Burt N, Warren T: Accidental middle turbinectomy: A complication of nasal intubation. A nesthesiology 1999; 90:1782–4Williams, AR Burt, N Warren, T
Scamman FL, Babin RW: An unusual complication of nasotracheal intubation. A nesthesiology 1983; 59:352–3Scamman, FL Babin, RW
Cooper R: Bloodless turbinectomy following blind nasal intubation (letter). A nesthesiology 1989; 71:469Cooper, R
Dost P, Armbruster W: Nasal turbinate dislocation caused by nasotracheal intubation. Acta Anaesthesiol Scand 1997; 41:795–6Dost, P Armbruster, W
Kawamoto M, Shimidzu Y: A balloon catheter for nasal intubation (letter). A nesthesiology 1983; 59:484Kawamoto, M Shimidzu, Y
Morais D, Carranza MA, Condado MA, Bachiller J: Lateral pharyngeal phlegmon following nasotracheal intubation. Acta Otorrinolaringol Esp 1992; 43:349–51Morais, D Carranza, MA Condado, MA Bachiller, J
Hajjar J, Baylot D, Navez ML: A rare cause of obstruction of the intubation tube. Ann Fr Anesth Reanim 1993; 12:321–2Hajjar, J Baylot, D Navez, ML
Landess WW: Retropharyngeal dissection: A rare complication of nasotracheal intubation revisited—a case report. AANA J 1994; 62:273–7Landess, WW
Watanabe S, Yaguchi Y, Suga A, Asakura N: A “bubble-tip” (Airguide) tracheal tube system: Its effects on incidence of epistaxis and ease of tube advancement in the subglottic region during nasotracheal intubation. Anesth Analg 1994; 78:1140–3Watanabe, S Yaguchi, Y Suga, A Asakura, N
Cohen SP, Anderson PL: Mucoid impaction following nasal intubation in a child with an upper respiratory infection. J Clin Anesth 1998; 10:327–30Cohen, SP Anderson, PL
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
Fig. 1. Esophageal stethoscope and endotracheal tube (ETT) combination. Injecting about 6 ml of air and locking 3-way stopcock keeps the distal portion of esophageal stethoscope inflated to the same diameter of ETT.
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