Ver el código de «Nasal intubation»

==Indications==
[[File:F2.png|thumb|Normal anatomy of the nasal sinuses.]]
[[File:F6.png|thumb|Sagittal section through the head and neck showing the subdivisions of the pharynx.]]
*Severe cervical spine disease/instability
*Intra-oral masses or other limiting pathology such as mandibular fixation
*Trismus
*Severe angioedema

==Contraindications==
===Absolute===
*[[Epiglottitis]]
*Significant [[facial trauma|midface fractures]]
*[[Basilar skull fracture]]s

===Relative===
*Large nasal masses
*[[Nasal foreign body]]
*Recent nasal instrumentation
*Nasal or upper airway hematoma/infection
*[[Epistaxis]]

==Awake Technique==
#Sniffing position (like oral ET)
#Pretreat with [[glycopyrrolate]] 0.2mg or 0.04 mcg/kg and [[lidocaine|lido]], [[benzocaine|hurricaine]], or 4cc nebulized [[lidocaine]] for 5 minutes
#Also consider topical cocaine to the nares, typically 4% solution, for 2-3 minutes or intranasal [[phenylephrine]]
#Provide sedation with small doses of ketamine (10-20mg aliquots as needed) or midazolam
#Tube size = 1.0 mm smaller
#Listen with stethoscope  at end of tube (breath sounds become louder as tube approaches cords)
#When tube hits cords patient will cough, back up 1 or 2 cm.  wait for beginning of inspiration, as patient begins inspiration advance 3-4 cm (tube should be 22-26cm in women, 23-28cm in men)

*Tips:
**Occlude other nostril to hear better
**Cricoid pressure when advancing
**Use a small suction catheter as a seldinger guide
**Precurve tube before insertion.

==[[sedation|Sedated]] Technique==
#Prepare [[Afrin]] in 10 cc syringe, nasal trumpet, nasal tube (or smaller ETT) without stylet, DL blade, McGills/long curved Kellys
#Afrin in both nostrils
#Nasal trumpet into right nostril to dilate nasal airway (R nostril = less bleeding, faster<ref>Boku et al. Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial. J Clin Anesth. 2014 Aug;26(5):390-4.</ref>
#Insert tube in a postero-inferior direction (may feel some crunching along ethmoid, so be careful along that surface)
#DL to visualize tube insertion past vocal cords
#McGills or Kellys to grasp tube tip and facilitate passing tube

==See Also==
{{Related Difficult Airway Pages}}
{{Mechanical ventilation pages}}

==External Links==
*[https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-arrest/tracheal-intubation?query=nasotracheal%20intubation Merk Manual - Nasotracheal Intubation]

==References==
<references/>

[[Category:Critical Care]]
[[Category:Procedures]]