Difficulties with tooth protectors in endotracheal intubation

Area of Science:

• Anesthesiology
• Dental Surgery
• Medical Device Evaluation

Background:

• Routine use of tooth protectors during endotracheal intubation is common.
• Potential complications include airway obstruction and dental trauma.
• Existing protector designs may present challenges for anesthesiologists.

Purpose of the Study:

• To assess the suitability of three different tooth protectors for routine use during endotracheal intubation.
• To identify the main disadvantages and potential hazards associated with these devices.
• To provide recommendations for improving patient safety and intubation success rates.

Main Methods:

• A prospective study involving 300 consecutive patients undergoing elective surgery under general anesthesia.
• Evaluation of three distinct tooth protector devices.
• Data collection on intubation difficulty, visibility, and adverse events.

Main Results:

• Protectors frequently caused lack of space, hindering endotracheal tube guidance and reducing visibility, particularly with the Camo protector.
• Modifications, such as altering the Camo protector's angle, could mitigate some difficulties.
• Less experienced anesthesiologists encountered significant challenges; 20% of Camo protector cases were deemed un-intubatable without removal.
• The Camo protector's silicone inlay melted at body temperature, posing a hazard.
• Two patients experienced dental trauma (loss of maxillary incisor) despite using a Denex protector.

Conclusions:

• Current tooth protector designs present significant challenges during endotracheal intubation, impacting ease of use and safety.
• Protector-related issues, including airway obstruction and material degradation, necessitate design improvements.
• Routine use of tooth protectors does not eliminate the risk of dental trauma; comprehensive pre-anesthetic dental evaluation is crucial for optimal patient outcomes.