Nasal Intubation

Nasal Intubation can be accomplished by special nasal tubes or by simple oral tubes.

Advantages of nasal intubation over oral intubation:

1. Better fixation and therefore less chances of accidental extubation.

2. No possibility of tube occlusion by biting.

3. Better oral hygiene can be maintained.

4. Oral feeding is possible.

5. Better tolerated by patient.

Disadvantages of Nasal Intubation:

1. Increased chances of bleeding.
2. Increased chances of bacteremia (sinusites, otitis, meningitis).
3. Trauma to nasal structures,
4. Nasal deformities on long term use.

During intubation through nose bevel end of tube should be towards the septum to avoid trauma to inferior turbinate,

Indications for Nasal Intubation

1. Obstructing mass in oral cavity.
2. Oral surgery.
3. Fracture mandible (mouth opening not possible).
4. Inadequate mouth opening because of temporomandibular joint dysfunction.
5. Neck injury: For cervical spine injury intubation through nose is preferred over oral.
6. For awake intubation, nasal intubation is preferred over oral intubation.
7. When tube is to be kept for prolonged periods in intensive care units (nasal intubation is better tolerated bypatient).

Contraindications for Nasal Intubation

1. Basal skull fractures and CSF rhinorrhea (there have been case reports of tube reaching cranium and also CSF leak into nose can cause cerebral infection).
2. Bleeding disorders (nasal and septal mucosa are highly vascular areas).
3. Nasal polyp, Abscess, foreign body.
4. Previous nasal surgery is only relative contraindication.
5. Adenoids.

Contraindications for Both Nasal and Oral lntubation

• Laryngeal edema.
• Epiglotitis.
• Laryngotracheobronchitis

Attempt to intubate can aggravate these conditions and can produce severe respiratory Obstruction so in these conditions whenever there is severe respiratory distress, tracheostomy is preferred.

If intubation has to be performed it should be very gentle with expert hands and should be tried only in mild cases.

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