Enk Dietmar, Palmes Anne M, Van Aken Hugo, Westphal Martin
Department of Anaesthesiology and Intensive Care, University of Münster, Albert-Schweitzer-Strasse 31, 48149 Münster, Germany.
Anesth Analg. 2002 Nov;95(5):1432-6, table of contents. doi: 10.1097/00000539-200211000-00061.
Our hypothesis was that nasopharyngeal passage of an endotracheal tube can be facilitated by a nasopharyngeal airway (Wendl tube) acting as a "pathfinder." Accordingly, we performed a randomized, controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, a Wendl tube (28 Ch) was inserted into the more patent nostril. In the control group (n = 30), the Wendl tube was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter, 7.0 mm). In the intervention group (n = 30), the Wendl tube was kept in position and only its adjustable flange was removed. Then, we inserted the tip of the endotracheal tube into the trailing end of the Wendl tube. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx guided by the Wendl tube. After the endotracheal tube was positioned in the oropharynx, the Wendl tube was removed and intubation completed. Six hours after surgery, we determined the patients' nasal pain. The "pathfinder" technique reduced the incidence (P < 0.001) and severity (P = 0.001) of bleeding, decreased tube contamination with blood and mucus (P < 0.001), and diminished postoperative nasal pain (P = 0.036).
Nasopharyngeal passage of an endotracheal tube can be facilitated by a flexible Wendl tube (nasopharyngeal airway) covering and guiding the rigid tube tip. This technique is helpful in reducing the incidence and severity of nosebleeds and in minimizing contamination of the tip of the endotracheal tube with blood and mucus.
我们的假设是，鼻咽通气道（温德尔管）作为“探路者”可促进气管内导管通过鼻咽部。因此，我们进行了一项随机对照试验，对鼻咽部出血和气管内导管尖端污染进行盲法评估。麻醉诱导后，将一根28号的温德尔管插入较通畅的鼻孔。在对照组（n = 30）中，在尝试用气管内导管（内径7.0 mm）通过鼻咽部之前取出温德尔管。在干预组（n = 30）中，将温德尔管保留在位，仅移除其可调节凸缘。然后，将气管内导管尖端插入温德尔管的尾端。随后，在直视下将气管内导管在温德尔管引导下推进至口咽部。气管内导管置于口咽部后，取出温德尔管并完成插管。术后6小时，我们评估了患者的鼻部疼痛情况。“探路者”技术降低了出血的发生率（P < 0.001）和严重程度（P = 0.001），减少了导管被血液和黏液污染的情况（P < 0.001），并减轻了术后鼻部疼痛（P = 0.036）。
可弯曲的温德尔管（鼻咽通气道）覆盖并引导刚性的导管尖端，有助于气管内导管通过鼻咽部。该技术有助于降低鼻出血的发生率和严重程度，并使气管内导管尖端被血液和黏液污染的情况降至最低。
