Retrograde nasotracheal intubation with a new tracheal tube: a feasibilitystudy

We have assessed the feasibility of retrograde nasotracheal intubation usin g a flexometallic tracheal tube with a detachable pilot balloon and connect or in a study of 20 consecutive adult patients undergoing oropharyngeal sur gery. The technique consisted of: (I) laryngoscope-guided orotracheal intub ation; (2) insertion of an 18-gauge Foley catheter through the nose and ret raction into the mouth; (3) detachment of the anaesthesia circuit, pilot ba lloon and connector; (4) insertion of the Foley catheter tip into the proxi mal end of the tracheal tube and inflation of the Foley catheter cuff; (5) withdrawal of the Foley catheter and attached tracheal tube back through th e nose; (6) deflation of the Foley catheter cuff; and (7) re-attachment of the pilot balloon, connector and anaesthesia circuit. The technique was suc cessful at the first attempt in all patients. Mean time taken to insert the Foley catheter and retract it into the mouth was 19 (range 12-30) s. Mean time taken from disconnection to reconnection of the anaesthesia circuit wa s 8 (6-10) s. Heart rate increased after intubation, but there were no sign ificant changes in arterial pressure. Nasal bleeding, airway problems and h ypoxic events did not occur. No anatomical abnormalities or nasal trauma we re detected at rhinoscopy. We conclude that retrograde nasotracheal intubat ion is feasible using a flexometallic tracheal tube with a detachable pilot balloon and connector.