Hughes S, Smith J E
Department of Anaesthesia, Selly Oak Hospital, University Hospital, Birmingham.
Anaesthesia. 1996 Nov;51(11):1026-8. doi: 10.1111/j.1365-2044.1996.tb14996.x.
We have assessed the effectiveness of three tracheal tube rotational movements in assisting nasotracheal tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. In group 1, no rotation was used and the tube was advanced towards the trachea in the neutral position. In group 2, the tube was rotated by 90 degrees anticlockwise. In group 3, the tube was rotated by 180 degrees anticlockwise, then rotated back to 90 degrees anticlockwise (overcorrected rotation). If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group 1 (63%). It is therefore recommended that 90 degrees anticlockwise or overcorrected 90 degrees anticlockwise tube rotation is used to facilitate nasotracheal tube placement during fibreoptic intubation.
我们评估了三种气管导管旋转动作在辅助经纤维喉镜进行鼻气管插管时的有效性。研究了90例在全身麻醉下接受纤维鼻气管插管的美国麻醉医师协会（ASA）1或2级口腔外科患者。在纤维喉镜置入气管后，患者被随机分为三组。第1组不进行旋转，导管在中立位向气管推进。第2组，导管逆时针旋转90度。第3组，导管逆时针旋转180度，然后再逆时针旋转回90度（过度矫正旋转）。如果推进时遇到阻力，在按照标准的、逐步递增的顺序进行进一步旋转操作后，最多可再尝试两次。第2组和第3组首次尝试时导管成功置入的比例（分别为93%和100%）显著高于第1组（63%）。因此，建议在纤维喉镜插管期间采用逆时针90度或过度矫正的逆时针90度导管旋转，以促进鼻气管插管。
