Conventional nasotracheal intubation is commonly associated with injury to the passage tissues, such as the mucosal lining of the turbinates. Nasal polyp, teared mucosa and blood clots are potentially hazardous, since it lodge in a bronchus or obstruct a tracheal tube. So atraumatic intubation is very important point during nasotracheal intubation.

Fourty patients were divided into two groups, Mallinckrodt reinforced tube(n=20) and esophageal stethoscope inserted into the Mallinckrodt reinforced tube(n=20). The esophageal stethoscope was inserted into the Mallinckrodt reinforced tube until the distal end of the esophageal stethoscope reached about 5 mm beyond the distal end of the Mallinckrodt tube. The esophageal stethoscope was inflated using an air-filled syringe through a three-way stopcock. After defasciculating dose of pancuronium 0.5~1 mg intravenously, the patients were given thiopental 4~5 mg/kg, succinylcholine 1~2 mg/kg and lidocaine 1.5 mg/kg with 100% oxygen ventilation via face mask. After lubrication of the appropriate tracheal tube with jelly, it was gently advanced beyond the nasopharynx. The tube tip was manipulated into the larynx with the aid of a Magill intubating forceps. The incidence of epistaxis was compared between the two groups.

The esophageal stethoscope inserted into the reinforced tube group had a significantly lower incidence of nasal bleeding than reinforced tube only (1/20 vs 18/20 : P<0.01).

The esophageal stethoscope inserted into the reinforced endotracheal tube helps to minimize nasal bleeding during nasotracheal intubation.