NASOTRACHEAL TUBE CUFF INFLATION AS AN AI D TO DIFFICULT INTUBATION

A case is reported of an unexpected difficult nasotracheal intubation for respiratory distress syndrome in a 72-yr-old obese woman with chro nic obstructive pulmonary disease. After positioning the tip of the tr acheal tube in the oropharynx, direct laryngoscopy did not allow expos ure neither of the glottis nor of the corniculate cartilages. Fibreopt ic tracheal intubation was decided. While preparing fibreoptic instrum ents, an attempt at blind intubation was performed. The tracheal tube cuff was inflated with 15 mL of air and then advanced gently until sli ght resistance was felt as the inflated cuff made contact with the voc al cords. At that time it was deflated and the tracheal tube advanced into the trachea. In the presence of normal pharyngeal anatomy, inflat ion of the tracheal tube cuff in the oropharynx is assumed to centre t he tip of the tube and to direct it anteriorely towards the larynx. A recent prospective and randomized study has shown that tracheal tube c uff inflation in the oropharynx is effective in improving the success rate of blind nasotracheal intubation in paralysed patients with norma l pharyngeal anatomy. Only case reports have shown the efficacy of tra cheal tube cuff inflation in the pharynx as an aid to difficult blind nasotracheal intubation in emergency. Further controlled studies in th is area would be valuable.