NASOTRACHEAL INTUBATION IN PATIENTS WITH IMMOBILIZED CERVICAL-SPINE -A COMPARISON OF TRACHEAL TUBE CUFF INFLATION AND FIBEROPTIC BRONCHOSCOPY

Tracheal intubation may pose problems in patients with cervical spine injury (CSI). In patients without CSI, the success rate of blind nasot racheal intubation is increased by endotracheal tube (ETT) cuff inflat ion in the pharynx The purpose of this study was to assess the efficac y of ETT cuff inflation in the pharynx as an aid to blind nasotracheal intubation in patients with an immobilized cervical spine. The techni que was compared with fiberoptic bronchoscopy. Twenty ASA physical sta tus I and II patients undergoing elective surgery in which the trachea was to be intubated nasally were enrolled in this prospective, random ized study. The cervical spine of each patient was immobilized. The tr achea of each patient was intubated twice, once using fiberoptic bronc hoscopy and once blindly using the technique of ETT cuff inflation in the pharynx. A maximum of three attempts was allowed for intubation us ing ETT cuff inflation. A maximum of 3 min was allowed for intubation using fiberoptic bronchoscopy. When ETT cuff inflation was used, intub ation was successful in 19 of 20 patients (95%); the first attempt at intubation was successful in 14 of 20 patients (70%). Intubation was s uccessful in 19 of 20 patients (95%) when using fiberoptic bronchoscop y. Mean times to intubate were 20.8 +/- 23 s when the ETT cuff was inf lated in the pharynx and 60.1 +/- 56 s when using fiberoptic laryngosc opy (P < 0.01). We conclude that both ETT cuff inflation in the pharyn x and fiberoptic bronchoscopy are valuable for nasotracheal intubation in patients with an immobilized cervical spine and that ETT cuff infl ation can be used as an alternative to fiberoptic bronchoscopy in pati ents with CSI. Implications: We compared the technique of endotracheal tube cuff inflation in the pharynx for blind nasotracheal intubation in patients with an immobilized cervical spine with fiberoptic broncho scopy. There was no significant difference between the success rates o f the techniques.