An alternative anesthetic technique can be employed when conventional nasal intubation methods do not work.. The method involves a gum elastic bougie (GEB) device, which is useful for difficult airway management but seldom has been used for nasotracheal intubation.

The benefits of this GEB use are explained in an article in the September 2010 issue of Anesthesia Progress.

The authors report how this application of GEB for nasal endotracheal intubation was performed in 16 patients whose tracheas could not be intubated by conventional techniques because of anatomical problems or misdirection of the tip of the tracheal tube. These patients were among 632 people undergoing dental procedures or oral surgery.

The authors explain how to place and connect the nasal tube for optimal use. They note that the use of several other mechanical aids including suction catheters, nasogastric tubes, stylets, and nasal flexible laryngeal masks has been reported previously for nasal intubation.

In instances when mouth opening is limited or prohibited, the authors note that fiber-optic intubation can be an effective approach to intubation, although they have found it to be time-consuming. Because of this, they suggest application of GEB as a good alternative.

"In our experience with use of these methods, this GEB technique is very quick, safe, inexpensive, and easy to perform," the authors write. "Thus, we recommend the use of GEB from the first attempt for nasal endotracheal intubation in patients with difficult airways."

Source: Allen Press Publishing Services