Nasotracheal Intubation Over a Bougie

The purpose of this study is to determine whether nasal intubation over a bougie placed via a nasal trumpet will decrease nasal trauma when compared to the conventional technique of blind nasal endotracheal tube passage.

Conventional nasotracheal intubation techniques (or "Conventional Videolaryngoscopic Techniques," CVT) are known to be associated with significant trauma to the patient's nares and the endotracheal tube itself. The investigators propose an alternative technique (Nasotracheal intubation over a bougie placed via a subsequently removed nasal trumpet, or NIB) which involves using Seldinger technique over a bougie placed via a nasal trumpet which promises to not only be less traumatic to the patient and the endotracheal tube, but also to take less time to perform and have a higher first-attempt success rate than conventional methods. The investigators propose a randomized prospective interventional study comparing this new technique with conventional technique to see if a significant difference exists.

Blind passage of an endotracheal tube via the nare followed by videolaryngoscopy-assisted passage through the glottis, with or without the aid of Magill forceps

Nasotracheal intubation over a bougie, placed with videolaryngoscopy assistance, via a nasopharyngeal airway with or without the aid of Magill forceps

Abrons technique for nasotracheal intubation, Nasotracheal intubation over a bougie placed via a subsequently removed nasal trumpet, NIB

Nasotracheal intubation over a bougie, placed with videolaryngoscopy assistance, via a nasopharyngeal airway with or without the aid of Magill forceps

Blind passage of an endotracheal tube via the nare followed by videolaryngoscopy-assisted passage through the glottis, with or without the aid of Magill forceps

Time from first entrance of ETT or bougie into the nare to the presence of end-tidal CO2 via nasotracheal ETT

Inclusion Criteria: Patients scheduled for elective surgery with an anesthetic plan including asleep nasotracheal intubation Exclusion Criteria: Patients needing emergent airway protection Patients undergoing emergency surgery Patients whom are known to be pregnant Patients whom are currently anticoagulated (including daily aspirin use) Patients whose anesthetic includes the use of nitrous oxide Patients whom are currently incarcerated Patients 7 years of age or younger Mentally incompetent adults Patients whom refuse involvement in the study

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