The Nose

The ENT anesthesia rotation gives us a lot of opportunity to do nasal intubations. While perhaps the notion of nasal intubation seems scary - after all, how many of us think we could breathe adequately through only one nostril - it turns out that patients tolerate the tube and breathe easily. We use a nasal endotracheal tube for cases where the surgeons are in the mouth and don't want any obstacles to work around - surgeries for obstructive sleep apnea, jaw surgeries, dental rehabilitation. There are a few ways of putting them in, and they're fun to practice. The simplest way is to carefully introduce the breathing tube into the nose, take a look with a direct laryngoscope in the mouth, and use forceps to advance the tube into the trachea. But I've recently become fond of using a video laryngoscope and watching the tube go through the cords without lifting the jaw too much. Doing so helps me appreciate that these nasal tubes are often positioned to go smoothly into the trachea without much manipulation. In the past, anesthesiologists used to do blind intubations and simply advance the tube, listening for breath sounds. Although this sounds precarious, it seems to work. The last technique we practice for nasal intubations is using a flexible fiberoptic bronchoscope, guiding the tube in over a flexible hand-controlled camera.

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