Effect of minimal cuff inflation with thermo softening of the endotracheal tube to minimize the trauma during naso tracheal intubation – observational study

Introduction and Objective: Several techniques and modifications have been to put forward to decrease the decrease nasopharyngeal trauma and epistaxis. This study evaluated the effect on partial inflation of the thermo softened endotracheal tube cuff to reduce bleeding. Materials and Method: This observational study was done at IRT Perunthurai Medical college Hospital after the institutional ethical committee approval between April 2013 and August 2013 at the main operating theater complex. 20 patients who were scheduled for open reduction and internal fixation of mandible that required nasal intubation were chosen following a formal written informed consent. Nasal pharyngeal anatomy was screened by an ENT surgeon and noted accordingly as a part of pre-anaesthetic assessment for adequate nasal patency. In the operating room after nasal decongestion and lubrication appropriate thermo softened tube is introduced in the preferred nostril with the cuff inflated with a minimal volume of air not exceeding 2 milliliters. Ease of passage of the endotracheal tube, degree of bleeding during laryngoscopy and post-operative nasal pain were observed by the anaesthesiologist who performed the laryngoscopy and Magill forceps assisted nasotracheal intubation. Results: When observed the bleeding ranged from a thin to a thick streak which indicated that there is definitive reduction in the amount of trauma induced by the passage of the inflated thermo softened endotracheal tube with minimal cuff inflation. Conclusion: Partial inflation of the cuff in a thermo softened tube was found to be very effective in reducing the nasopharyngeal trauma thereby significantly decreased the incidence of epistaxis and its related complications.