CR#19 Use of the nasotracheal Airtraq to assist difficult nasal fibreoptic intubation

Canadian Journal of Anesthesia December 2008; 55: 12
P. Schoettker et  Al. University Hospital CHUV, Lausanne, Switzerland

A 40-yr-old 85-kg man, was wearing a custom-made moulded thoracocervical rigid collar due to an unstable C2 fracture, and a Mallampati grade IV with a mouth opening of 15 mm.

Nasotracheal fibreoptic intubation with a 6.5-mm nasotracheal tube was attempted and unsuccessful due to copious bloody secretions and a collapsed orotracheal pathway.

Airtraq® was introduced through the patient’s mouth while fibrescopy was still in progress. At this point, the epiglottis and vocal cords were easily visualized. The nasotracheal Airtraq® operator gave verbal directions (up, down, left, right, forward, and back) for the fibrescopy, and tracheal intubation was achieved.

The successful completion of this case, in the face of bleeding from nasal mucosa and a limited mouth opening due to the presence of a cervical collar, illustrates a potential role for the nasotracheal Airtraq® device in a difficult nasotracheal intubation under general anesthesia.

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