I do a lot of nasal intubations and had an interesting problem today. It may be hard to describe it, but I will try and hope that some of you would give me your thoughts.

Sixty five year old male in good health, no history of nasal surgery or trauma, scheduled for facelift. Patient had patent nares, no recent nasal or sinus issues. I used a 7.5 mm nasal rae tube, prewarmed in saline. I always try blind, but needed direct vision on him and tube was inserted with ease and without Magills. Bilateral breath sounds and CO2 wave form and 5.3% end-tidal reading.

The problem was that the tube kept coming out of the nose and I while I am sure it was still in, it keep coming out of the nose (about 4 inches from initial insertion). I changed the head position, deflated the tube, checked with laryngoscope, and could find no problem. At the end of the case, I deflated the tube and could not extubate him. The tube got hung up somewhere in the nasal passage. With a little more brute force than I like to use, I was able to get the tube out and on inspection, I saw no indication of kinks or torque. Patient is fine. Any thoughts.


PS. This is what makes anesthesia fun even after close to 51 years.