Conversion of nasal to oral intubation

The GlideScope for videolaryngoscopy-assisted nasotracheal-to-orotracheal tube exchange in the intensive care unit in a patient with a known difficult airway

A 77 year old, nasally intubated man with a history of repeated episodes of airway obstruction requiring intubation due to recurrent laryngitis and a hypopharyngeal mass, needed nasotracheal-to-orotracheal tube exchange. The GlideScope videolaryngoscope was inserted, achieving a full view of the glottic inlet with the nasotracheal tube in situ. An endotracheal tube (ETT) loaded on a GlideRite Rigid Stylet was advanced through the oropharynx into view. Advancement of this ETT to the glottic opening was tested and achieved. With both tracheal tubes in view, the nasotracheal tube cuff was deflated and withdrawn from the glottic opening. While maintaining videoscopic visualization, the orotracheal tube was advanced through the vocal cords into the trachea. The benefits of this technique versus existing alternatives are discussed.

The Laryngeal Mask Airway for exchange of a nasal for an orotracheal tube in a patient with Treacher Collins syndrome

A new method of exchange of nasotracheal to orotracheal tube, using the Laryngeal Mask Airway (LMA), in a patient with difficult airway, is described. A 36-year-old woman with Treacher Collins syndrome was scheduled for a malar apatite cutting and a chin-level osteotomy. It was necessary to exchange a nasotracheal tube for an orotracheal tube during the operation. An LMA was inserted while the nasotracheal tube was left in place; a new tube was inserted in the LMA, then a fiberoptic laryngoscope (fiberscope) was inserted through these devices. The nasotracheal tube cuff was deflated, and the fiberscope was inserted into the trachea alongside the nasotracheal tube. The nasotracheal tube was removed, and the oral tube was then advanced into the trachea.