How to Insert an Tracheal Tube during Nasotracheal Intubation

When a Tube Sticks to the Anterior Wall of Trachea

Abstract

During nasotracheal intubation, sometimes it is difficult to advance a tube just beyond the vocal cord. In such cases, changing the neck position and/or using a Magill forceps could make the tube advance. However, changing the neck position might damage the neck and rough management of the tube might injure tracheal tissue or cause laryngeal edema. We found an easy way to resolve the problem without such troubles.
When the tube can not be advanced further just beyond the vocal cord, connect the circuit to the tube, close the mouth and another naris and ventilate with 15-20cmH₂O two or three times. Subsequently advance the tube again. This procedure is very easy and can advance the tube successfully.