Blind Nasal Intubation Revisited: No Longer a Blind Technique?

SONOSIM SUMMARY: This case report examines the use of capnography in conjunction with ultrasonography (US) to assist with nasal intubation. In modern medicine, blind nasal intubation (BNI) has been widely branded as obsolete; however, the two examples referenced in this report suggest that US and capnography assisted nasal intubation can be a potentially lifesaving procedure under certain circumstances. US guidance reduces many of the risks associated with BNI, such as trauma and hemorrhage along the nasal and nasopharyngeal passages, particularly around the glottic opening. The report also finds that US may be useful in minimizing manipulation of the neck in cases involving cervical spine instability. The report highlights the widespread availability of capnography and US in healthcare, and US training for airway management is highly recommended.

Dubey PK, Dubey P, Kumar N, et al. Blind nasal intubation revisited: no longer a blind technique? J Emerg Med. 2017 Feb;52(2):231-234.

Abstract

Background
Advancements in airway management have made the practice of blind nasal intubation obsolete. We report on successful blind nasal intubation performed with the help of capnography and real-time ultrasonography in two patients with tempormandibular joint ankylosis.

Case Report
Blind nasal intubation was performed in a 12-year-old patient and a 17-year old patient under general anesthesia with spontaneous respiration. Capnography was used as an aid during insertion and dynamic ultrasonography was performed to guide and confirm proper tracheal tube placement. Use of capnography helps in following the correct path toward the glottic opening, with quick detection of any obstruction, and with confirmation of final placement of the tracheal tube. Ultrasonography aids with entry into the glottis and with identifying the correct placement. We recommend the use of this modified blind nasal intubation in patients with limited mouth opening when equipment, such as a fiberoptic scope, is not available or is nonfunctional in the emergency department.

Why Should an Emergency Physician be Aware of This?
Adapting this technique will add to the armamentarium available for airway management in emergency medicine, particularly in maxillofacial injuries with limited mouth opening.

To read the article, visit the Journal of Emergency Medicine.

SonoSim Keywords: Bedside Ultrasound, Ultrasound-Guided Nasal Intubation