Nasopharyngeal intubation tips
Posted by dkwinter
  • Consider ketamine as it provides analgesia (add midazolam)
    • If may increase secretions so consider
      • Atropine 0.5 mg OR
      • Glycopyrrolate
  • Use topical anesthetics too
    • Oxymetazoline or Neosynephrine
    • Lidocaine nebule (4% lidocaine with 5cc saline)
      • Good because it anesthetizes all the way to the vocal cords
    • Need nasopharyngeal bronchoscope
    • ET tube (at least a 7.0 to ensure enough length
  • Procedure
    1. Spray topical anesthetic
    2. Lubricate nasal trumpet with lidocaine jelly and insert into one nare (determine most patent nare with flow test)
    3. Administer lidocaine neb
    4. Lubrate ET tube with sterile jelly and load onto the scope
    5. Remove nasal tumpet
    6. Insert scope and advance straight back then down until you see the carina
    7. Advance tube over the scoe to a depth of 26-28 cm.
    8. With draw the scope
    9. Inflate balloon
    10. Confirm tube placement
    11. Administer both sedative (propofol) and paralytic