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Simple preoperative assessment to reduce the risk of traumatic epistaxis during nasotracheal intubation

Kayarkar, R.; Woolford, T. J.; Francis, G. A.

European Journal of Anaesthesiology: September 2002 - Volume 19 - Issue 9 - p 690-691

Department of Otorhinolaryngology; Royal Hallamshire Hospital; Sheffield, UK (Kayarkar, Woolford)

Department of Anaesthesia; Royal Hallamshire Hospital; Sheffield, UK (Francis)

Correspondence to: R. Kayarkar, Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. E-mail:; Tel: +44 (0)114 2712239; Fax: +44 (0)114 2711985

Accepted for publication April 2001 EJA 456


Nasotracheal intubation is a common technique used when surgeons operate in the oral cavity. Since it is a blind procedure, complications can occur due to trauma to the nasal septum medially and turbinates laterally. Epistaxis is one of the more common complications of nasal intubation [1,2]. In the majority of cases, it is mild to moderate, but at times it can be severe [3]. Various methods have been tried to lessen the risk of epistaxis and include the use of various topical vasoconstrictors [4-6], dilation of the nasal cavity [7] and using smaller tubes that have been softened by warming [8].

Deviation of the nasal septum is found in approximately 80% of the general population [9], although in most cases this is asymptomatic. The following simple preoperative assessment will assist in identifying septal deviation, and intubation can then be performed through the wider nasal cavity thus reducing the risk of trauma:

(a) Examination of the caudal septum can be performed by gently elevating the tip of the nose and using a pen torch for illumination (Fig. 1);

Figure 1

Figure 1

(b) Steaming seen on the steel spatula held under the nostrils (Fig. 2).

Figure 2

Figure 2

This simple preoperative assessment will assist the anaesthetist in selecting the wider nasal passage for nasotracheal intubation and reduce trauma to the nasal cavity.

R. Kayarkar

T. J. Woolford

Department of Otorhinolaryngology; Royal Hallamshire Hospital; Sheffield, UK

G. A. Francis

Department of Anaesthesia; Royal Hallamshire Hospital; Sheffield, UK

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© 2002 European Academy of Anaesthesiology