Nasotracheal tube placement over the fibreoptic laryngoscope

We have assessed the effectiveness of three tracheal tube rotational movements in assisting nasotracheal tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. In group 1, no rotation was used and the tube was advanced towards the trachea in the neutral position. In group 2, the tube was rotated by 90 degrees anticlockwise. In group 3, the tube was rotated by 180 degrees anticlockwise, then rotated back to 90 degrees anticlockwise (overcorrected rotation). If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group 1 (63%). It is therefore recommended that 90 degrees anticlockwise or overcorrected 90 degrees anticlockwise tube rotation is used to facilitate nasotracheal tube placement during fibreoptic intubation.