A Reliable Protocol for Fiberoptic Nasal Intubation

Nasotracheal intubation is crucial for many oral and maxillofacial surgery procedures; however, it presents more challenges than orotracheal intubation and requires a higher level of training, along with various execution options. The routine use of an endotracheal tube (ETT)-first nasal fiberoptic intubation protocol is recommended, specifically in cases where orotracheal intubation is not possible or feasible. In this proposed technique, 137 randomly selected patients underwent fiberoptic nasotracheal intubation for general anesthesia utilizing a strict ETT first protocol. The mean preintubation ETT depth was 14 cm from the nares, correlating this distance with the patient's height, weight, and gender, proposing a formula for depth selection. Inserting the nasal ETT to a mean depth of 14 cm prior to insertion of the fiberoptic scope resulted in excellent visualization of the glottis with a first pass success rate for intubation of 97.8% and a mean intubation time of 68.5 seconds, regardless of the expertise of the provider.