Nasotracheal intubations in the emergency department

Three hundred consecutive patients in whom nasotracheal intubation was selected as the method of airway management were prospectively evaluated for success and safety. The intubations were performed in the emergency department by 19 emergency medicine residents and staff. The success rate was 92% when performed "blindly" without Magill forceps. Translaryngeal anesthesia preceded the intubations in 86%. The complication rate for the techniques was 3%. In the 242 survivors, there was no significant or permanent laryngeal damage. The technique, indications, contraindications, advantages, disadvantages, and complications of nasotracheal intubation and translaryngeal anesthesia are reviewed. Nasotracheal intubation is an essential skill allowing a flexible approach to airway management.