Nasotracheal intubation is usually recommended when surgery in the oral cavity or on the mandible is facillitated by an unobstructed view.
If the mouth is to be wired or banded shut after surgery, a nasal tube must be used. Contraindication to nasal intubation include coagulopathy, sever intranasal pathology, basal skull fracture, land presence of a cerebrospinal fluid leak.
We experienced a case of blood aspiration during nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to mandible fracture. On preoperative evaluation, specific problem was not noted. During nasotracheal
intubation, epistaxis was developed and the aspiration of blood into the lung was occurred, accidentally. Operation was postponed and the patient was transferred to recovery room. In recovery room, a chest x-ray of left lung revealed decrease of
volume,
increase of interstitial marking, and more opaque finding than right lung.
Arterial blood gas revealed pH 7.43, PCO2 44mmHg, PO2 61mmHg. With frequent suction, encouraging expectoration, antibiotic therapy and O2 supplementation by nasal prong, patient was nearly normalized following 5 hours after the episode of
aspiration.
Carefully, retrial of nasotracheal intubation was done one week later under the preparation of bosmin (Jeil pharmacy) nasal packing and lubricated endotracheal tube. Intubation and the operation was finished uneventfully.
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