The Modified Nasal Trumpet: Revisiting a Novel Technique · spontaneously breathing patient. The...
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Poster Design & Printing by Genigraphics ® - 800.790.4001 A standard nasopharyngeal airway appropriate for the patient’s age and size is selected. An endotracheal tube connector is then inserted into the proximal end of the nasopharyngeal airway. This modified nasal trumpet can then be easily placed in the standard fashion. A Jackson Rees or AmbuBag device can be attached to the endotracheal tube connector to provide positive pressure. This is facilitated by using one hand to simultaneously close the contralateral nare, seal the mouth, and provide a jaw thrust similar to the technique used for bag-mask ventilation. Alternatively, the anesthesia circuit can also be attached to provide supplemental oxygen or inhalational anesthesia, and end-tidal carbon dioxide monitoring can also be performed. This technique can be utilized to provide a more controlled setting while performing fiberoptic intubation through the contralateral nasal airway. The technique is simple and effective and utilizes materials that are readily available. It eliminates issues with poor mask fit and allows access to the oral cavity during the administration of anesthesia. Most importantly, the modified nasal trumpet technique is easily learned. The modified nasal trumpet technique offers a method of quickly establishing a patent airway with the ability to administer supplemental oxygen and inhalational anesthesia. This technique is also useful in assisting with fiberoptic intubation. Additionally, end-tidal carbon dioxide monitoring can be performed. This proves especially useful in managing the spontaneously breathing patient. The modified nasal trumpet technique is an important skill in management of the difficult airway that should be familiar to all Otolaryngologists. It is useful in a wide variety of clinical settings in pediatric and adult patients and utilizes materials that are readily available. Many different techniques and a variety of instrumentation have been developed to assist in management of the difficult airway. Otolaryngologists represent a critical role in treating patients and establishing safe ventilation. It is, therefore, important to be aware of the use of the modified nasal trumpet technique. Beattie reported his experience in 2002 in which he reviewed the success with this technique in 35 patients over 15 years. In these difficult airway patients, many of whom could be classified as “cannot ventilate / cannot intubate,” a safe non- surgical airway was able to be readily established. In 2004, Metz reviewed the use of the modified nasal trumpet in 346 spontaneously breathing patients and concluded that the technique was useful when used alone to provide general anesthesia, to provide supplemental oxygen after extubation, and to facilitate fiberoptic intubation. INTRODUCTION Aron J, Thongrod S, Zhang X. The modified nasal trumpet: should it be a standard? Internet J Anesth 2008; 15(2). Beattie C. The modified nasal trumpet maneuver. Anesth Analg. 2002 Feb;94(2):467-9. Metz S, Beattie C. A modified nasal trumpet to facilitate fibreoptic intubation. Br J Anaesth. 2003 Mar;90(3):388. Metz S. Perioperative use of the modified nasal trumpet in 346 patients. Br J Anaesth. 2004 Apr;92(5):684-6. Walz R, Bund M. The modified nasal trumpet maneuver. Anesth Analg. 2002 Dec;95(6):1821. CONCLUSIONS TECHNIQUE REFERENCES The modified nasal trumpet technique has been successfully used by the senior author for decades. It is a useful tool in the management of the difficult airway and can also be used in situations where bag mask ventilation would be used. Previous reviews of this technique have advised cutting a Murphy eye in the distal end of the nasopharyngeal airway; however, we have found that this is not necessary when the size of the nasopharyngeal airway is properly selected and then the device is placed appropriately. Walz and Bund recommend an alternative to the use of the modified nasal trumpet. They suggest using a shortened endotracheal tube for the same purpose. However, the modified nasal trumpet is a superior choice due to its soft, flexible design which leads to less potential for trauma during insertion. DISCUSSION David Rodwell, MD 1 ; Jerome Thompson, MD, MBA 1 ; Joel Saltzman, MD 2 1 University of Tennessee Department of Otolaryngology - Head & Neck Surgery 2 Le Bonheur Children’s Medical Center Department of Anesthesiology The Modified Nasal Trumpet: Revisiting a Novel Technique ABSTRACT CONTACT David Rodwell, MD University of Tennessee Dept. of Otolaryngology - H&N Surgery Email: [email protected] Phone: 901-448-5885 Website: www.uthsc.edu/otolaryngology Objectives: 1.) Highlight an underutilized method for use of the nasal trumpet in management of the difficult airway. 2.) Review the application of this technique in multiple clinical scenarios. Methods: Report of technique and application in airway management. Results: There are a multitude of techniques and devices available to assist with intubation and ventilation for both the difficult patient and those that do not pose a significant challenge in airway management. The use of a nasal trumpet with an endotracheal tube connector represents an additional means of establishing ventilation and providing inhalational anesthesia. This technique has proven extremely useful by the senior author over many years in the pediatric population in a wide variety of clinical scenarios. We review the technique and clinical application. Conclusion: The use of the modified nasal trumpet has been previously reported in the Anesthesiology literature but represents a critical skill and technique of airway management that should be familiar to all Otolaryngologists.
Transcript of The Modified Nasal Trumpet: Revisiting a Novel Technique · spontaneously breathing patient. The...
Poster Design & Printing by Genigraphics® -800.790.4001
A standard nasopharyngeal airway appropriate for the patient’s age and size is selected. An endotracheal tube connector is then inserted into the proximal end of the nasopharyngeal airway. This modified nasal trumpet can then be easily placed in the standard fashion. A Jackson Rees or AmbuBagdevice can be attached to the endotracheal tube connector to provide positive pressure. This is facilitated by using one hand to simultaneously close the contralateral nare, seal the mouth, and provide a jaw thrust similar to the technique used for bag-mask ventilation.
Alternatively, the anesthesia circuit can also be attached to provide supplemental oxygen or inhalational anesthesia, and end-tidal carbon dioxide monitoring can also be performed. This technique can be utilized to provide a more controlled setting while performing fiberoptic intubation through the contralateral nasal airway.
The technique is simple and effective and utilizes materials that are readily available. It eliminates issues with poor mask fit and allows access to the oral cavity during the administration of anesthesia. Most importantly, the modified nasal trumpet technique is easily learned.
The modified nasal trumpet technique offers a method of quickly establishing a patent airway with the ability to administer supplemental oxygen and inhalational anesthesia. This technique is also useful in assisting with fiberoptic intubation.
Additionally, end-tidal carbon dioxide monitoring can be performed. This proves especially useful in managing the spontaneously breathing patient.
The modified nasal trumpet technique is an important skill in management of the difficult airway that should be familiar to all Otolaryngologists. It is useful in a wide variety of clinical settings in pediatric and adult patients and utilizes materials that are readily available.
Many different techniques and a variety of instrumentation have been developed to assist in management of the difficult airway. Otolaryngologists represent a critical role in treating patients and establishing safe ventilation. It is, therefore, important to be aware of the use of the modified nasal trumpet technique.
Beattie reported his experience in 2002 in which he reviewed the success with this technique in 35 patients over 15 years. In these difficult airway patients, many of whom could be classified as “cannot ventilate / cannot intubate,” a safe non-surgical airway was able to be readily established. In 2004, Metz reviewed the use of the modified nasal trumpet in 346 spontaneously breathing patients and concluded that the technique was useful when used alone to provide general anesthesia, to provide supplemental oxygen after extubation, and to facilitate fiberoptic intubation.
INTRODUCTION
Aron J, Thongrod S, Zhang X. The modified nasal trumpet: should it be a standard? Internet J Anesth 2008; 15(2).
Beattie C. The modified nasal trumpet maneuver. Anesth Analg. 2002 Feb;94(2):467-9.
Metz S, Beattie C. A modified nasal trumpet to facilitate fibreoptic intubation. Br J Anaesth. 2003 Mar;90(3):388.
Metz S. Perioperative use of the modified nasal trumpet in 346 patients. Br J Anaesth. 2004 Apr;92(5):684-6.
Walz R, Bund M. The modified nasal trumpet maneuver. Anesth Analg. 2002 Dec;95(6):1821.
CONCLUSIONS
TECHNIQUE
REFERENCES
The modified nasal trumpet technique has been successfully used by the senior author for decades. It is a useful tool in the management of the difficult airway and can also be used in situations where bag mask ventilation would be used. Previous reviews of this technique have advised cutting a Murphy eye in the distal end of the nasopharyngeal airway; however, we have found that this is not necessary when the size of the nasopharyngeal airway is properly selected and then the device is placed appropriately.
Walz and Bund recommend an alternative to the use of the modified nasal trumpet. They suggest using a shortened endotracheal tube for the same purpose. However, the modified nasal trumpet is a superior choice due to its soft, flexible design which leads to less potential for trauma during insertion.
DISCUSSION
David Rodwell, MD1; Jerome Thompson, MD, MBA1; Joel Saltzman, MD21University of Tennessee Department of Otolaryngology - Head & Neck Surgery
2Le Bonheur Children’s Medical Center Department of Anesthesiology
The Modified Nasal Trumpet: Revisiting a Novel Technique
ABSTRACT
CONTACT
David Rodwell, MDUniversity of Tennessee Dept. of Otolaryngology - H&N SurgeryEmail: [email protected]: 901-448-5885Website: www.uthsc.edu/otolaryngology
Objectives:1.) Highlight an underutilized method for use of the nasal trumpet in management of the difficult airway.2.) Review the application of this technique in multiple clinical scenarios.
Methods:Report of technique and application in airway management.
Results:There are a multitude of techniques and devices available to assist with intubation and ventilation for both the difficult patient and those that do not pose a significant challenge in airway management. The use of a nasal trumpet with an endotracheal tube connector represents an additional means of establishing ventilation and providing inhalational anesthesia. This technique has proven extremely useful by the senior author over many years in the pediatric population in a wide variety of clinical scenarios. We review the technique and clinical application.
Conclusion:The use of the modified nasal trumpet has been previously reported in the Anesthesiology literature but represents a critical skill and technique of airway management that should be familiar to all Otolaryngologists.
