British Journal of Anaesthesia Blind Nasotracheal Intubation Guided by an Image Intensifier

Sir,—According to Alexopoulus, Larson and Lindholm (1983), the airway aerogram obtained with x-rays is easily identifiable along its anterior aspect, from the epiglottis to about 60 mm below the vocal chords. Based on this evidence, and to avoid problems arising from technical difficulties during blind nasotracheal intubation, we have successfully used an x-ray image intensifier to guide the introduction of the tracheal tube between the vocal chords. We place the patient in a supine position, the head resting on a pillow 8-10 cm above the plane of the operation table. After good topical anaesthesia, the image intensifier is positioned so as to obtain a lateral x-ray view of the oropharyngotracheal aerogram. In this manner it is easy to identify basic anatomical structures such as hyoid bone, epiglottis, Morgagni's ventricles and the trachea. Once these elements are recognized on the screen, the endotracheal tube is inserted in the correct position. We consider that this technique can be useful during difficult blind nasal intubation.