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that the PFTT may be safer by causing less trauma and bleeding than the standard tube for nasotracheal intubation. A previous report from our hospital has demonstrated that the PFTT reduces the incidence of epistaxis during nasotracheal intubation and the incidence of postintubation nasal pain, as compared to conventional tracheal tubes. 4 Although thermosoftening is a well-known and effective technique for reducing epistaxis during nasotracheal intubation with conventional tracheal tubes, 5 we occasionally encounter difficulties in the nasal passage when the PFTT

anesthesiologists providing intubation. Among several approaches to minimizing the incidence of epistaxis and impingement, the efficacy of thermosoftening treatment of the polyvinyl chloride (PVC) NTT before nasotracheal intubation has been reported. 3 , 4 , 10 In the clinical application of thermosoftening treatment for nasotracheal intubation, the tip of the NTT should be kept at a high temperature without burning the mucosa; however, the thermosoftened NTT cools promptly to the ambient temperature of the room and consequently becomes stiffer. 4 The surface

nasotracheal intubation: the influence on nasal mucosal trauma . Anaesthesia . 2010 ; 65 : 8 – 11 . 11 Kim YC, Lee SH, Noh GJ, et al . Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage . Anesth Analg . 2000 ; 91 : 698 – 701 . 12

PONV, 25 Postoperative bleeding, 72 Postoperative swelling, 25 Prilocaine, 99 Propofol, 67, 162 Propofol drip infusion, 60 Salivary alpha amylase, 46 Salivary cortisol, 46 Sedation, 54 Sevoflurane, 67 Sonophoresis, 37 Stress, 46 Tapentadol, 178 Thermosoftening, 109 Tracheal tubes, 109 Trauma, 25

achieving full neuromuscular recovery while realizing the risk of impaired regulation of breathing and response to hypoxia may still be present during recovery despite complete neuromuscular blockade reversal. Kim EM, Chung MH, Lee MH, Choi EM, Jun I-J, Y, Yun TH, Ko YK, Kim JH, Jun JH. Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation? Anesth Analg . 2019;129:812–818. Thermosoftening of the cuffed endotracheal tube (ETT) and telescoping the ETT into a rubber catheter has been suggested as a method for

Epistaxis is one of the most common complications of nasotracheal intubation. 1 – 3 Various methods have been developed to prevent or reduce bleeding, including thermosoftening of the nasal endotracheal tube as well as use of the gum elastic bougie technique. 4 – 6 However, management of massive epistaxis after nasotracheal extubation has not been well addressed, even in reviews of nasotracheal intubation for head and neck surgery. 1 , 3 Depending on the surgical procedure, epistaxis may be more complicated and difficult to control

eases subsequent passage of the nasal tube, it should also be considered an optional step likely to prolong intubation times. Furthermore, it would appear logical to conclude that the risk of damage to the nasal mucosa increases with every subsequent airway/tube advancement, especially with the stiffer nasopharyngeal tubes that are readily available. This speaks to considering a minimalistic approach. Thermosoftening of the endotracheal tube is another generally recommended step, and it appears that this was carried out by all the anesthesiologists. The degree

, see Cohen H, 145 Reader A, see Smith S, 3 Riley C, see Yen P, 162 Ritwik P, Post-sedation Events in Children Sedated for Dental Care (scientific report), 54 Rocha JF, see Lima JL Jr, 45 Rosenberg M, see Sadi H, 46 Sachdeva A, see Yaday S, 95 Sadi H, Salivary Cortisol, Salivary Alpha Amylase, and the Dental Anxiety Scale (scientific report), 46 Sant'ana E, see Lima JL Jr, 45 Sanuki T, Thermosoftening of the Parker Flex-Tipe Tracheal Tube in Preparation for Nasotracheal Intubation

the NTT will traverse the inferior pathway. 81 – 83 Other techniques that have been shown to reduce the risk of epistaxis during NTI include application of a topical vasoconstrictor (eg, cocaine, phenylephrine, oxymetazoline) to the nasal mucosa, lubricating the NTT, thermosoftening the NTT up to 60°C, tunneling the NTT tip into a catheter, NPA, or surgical glove, and obturating the NTT tip with an inflated esophageal stethoscope. 74 , 84 – 93 Consideration can also be given to utilizing uncuffed NTTs for certain procedures and patients to reduce the

catheter guidance reduces epistaxis . Can J Anaesth . 2006 ; 53 : 295 – 298 . 4. Kim YC , Lee SH , Noh GJ , et al . Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage . Anesth Analg . 2000 ; 91 : 698 – 701 . 5. Watanabe