Optimal timing for telescoping endotracheal tube into an introducer during nasotracheal intubation

Epistaxis or postpharyngeal injury is the most common complication during nasotracheal intubation. Prior thermosoftening of the endotracheal tube [1] and using a red rubber catheter as an introducer [2] were suggested to prevent these complications. When both maneuvers were simultaneously implemented [3], the timing of attaching the red rubber catheter to the endotracheal tube is also crucial to the effectiveness of the injury prevention. If the red rubber catheter telescoped to the endotracheal tube in the beginning of anesthesia induction, even though after warmed water immersion, the tube thermosoftening effect would rapidly disappear after the process of the red rubber catheter manipulation in the cold operating room.

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