Dental office anesthesia nasal intubation with Jackson Rees circuit

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00:00So here's a full clip of me performing a nasal intubation for a dental procedure in the dental

00:07office. Full disclosure this patient did sign a social media release waiver. She was on board

00:15with everything in terms of this video being posted, this video being for educational purposes

00:21to show you know other anesthesia personnel and nasal intubation being done in the in the office.

00:27I know when I was training I would love to watch these types of videos and learn and see how I can

00:32better my own practice. So here I am in the office we're using a Jackson Reese circuit. Y'all can google

00:38that, google that, research it so you kind of understand what I'm doing here. There you can

00:43tell I have my propofol. She's already been pre-oxygenated. She has been sedated as well with

00:49our normal pre-induction stuff. Here I am going to give her a dose of propofol to get her off to sleep.

00:58And it's just a one-man show. I'm alone in the office. It's just myself. Sometimes you have dental

01:04assistants or even the dentist help. Sometimes you don't. You have to plan to be by yourself and

01:09do it all on your own and that's one of the situations I was in here. Kind of just did

01:12everything on my own and everything went great. So give her some propofol. She's going to get sleepy.

01:19Here's my Jackson Reese circuit. I'm going to kind of just give her the last bits of that oxygen.

01:25And I'm going to put some tape on her eyes just so we don't cause any trauma to the eyes there.

01:30And at this point bring the bed up a little just as if I'm in the OR. I don't have an anesthesia

01:35machine, but that's my circuit. That's essentially my bag and my APL valve. Here I am. I have my setup

01:42right next to me, my nasal tube. She's going to be getting a 6.5 nasal tube. And here we go.

01:48So I will insert it and I'll talk a little bit more about my technique once we finish here. But

01:53you always put the tube in first. Okay. You want to gently get it in there. Be real gentle. Less

01:58blood there. I have my MAC 3. I usually just DL these patients. I tend to have

02:03pretty straightforward luck when I just DL them. I don't really like to use a camera if I don't need

02:07to. And here I am. She was a little anterior for me. I don't paralyze these patients. So sometimes

02:12they're just slightly tighter. I have always have my McGill's ready. So always ready to pop the McGill's

02:17it and just give it a little bit of extra effort there. So you can touch the cords and I will advance

02:23and boom, we're in. Anyone who's done these can kind of see as soon as you're in, you pop right

02:29through it. It's a good feeling there. So she's doing good for me. And you guys can hear the monitor

02:34in the background. Anyone that's familiar with these noises without even knowing the numbers,

02:38you know she's probably somewhere in the mid-90s right now. She desat it just a touch as we

02:44as we induced her and got her off to bed there. So I have her attached to my Jackson

02:48Reese circuit with oxygen and also with a CO2 indicator, not indicator, a sample line for

02:56measurements. So I'm just giving her a few, few breaths of air here as she starts to come back

03:01breathing on her own. So she's not paralyzed. So the whole point of these cases is for them to be

03:07intubated, but we want them breathing on their own as soon as they can. It's almost like having an LMA

03:12and the OR. And you want to breathe them back as soon as they can, just to kind of

03:16help with kind of everything when it comes to respiratory. And same thing here, tube is in

03:20place, but I do want her to breathe on her own as soon as she can. So hurry, I'm just giving her

03:24a few breaths just to kind of make sure she sats in the hundreds. And as I tape and do all that good

03:29stuff, I want her to have a little bit of reserve. Anyone who's done nasal intubations know that the

03:33tape and the whole setup here, getting it secured is a little bit of a process. And I have a pretty cool

03:39technique I learned at one of my first jobs when I used to work down in New Mexico. A real good

03:45colleague of mine showed me a cool way to tape the head and check pressure points. And I've always

03:50had good luck with it. So here I am. You can tell, look, I'm by myself. I'm having to use my stomach

03:55here to kind of hold the tube in place while I tape my first layer of tape here to the actual skin.

04:02And like I say, I plan to always be on my own, be by myself. And if I have an extra set of hands

04:07helping me, wonderful. It's always nice. And if I don't, well, I've done this plenty of times on my

04:12own to know what I have to do to make sure the patient is super safe and things go great. So

04:17here I am, first layer of tape around the nose and kind of just making sure it doesn't go anywhere.

04:22And this is more so just to keep the tube in place as I do my next steps here. But

04:28that's secured to the nose and making sure it's not pulling on or putting pressure on any parts of the

04:33nose. And I'm actually giving her another breath there just to keep her oxygen nice. But I also

04:40don't mind a little CO2 to build a little bit just so those receptors in the brain and the midbrain and

04:45whatnot can start to say, hey, let's get some breathing going. And I disconnected her there

04:51because I'm going to put a piece of gauze underneath the attachment there, the little elbow, so we don't

04:57get any sores or anything on the forehead. And here's my blue towel. And so the rest of the video

05:05is me essentially just securing the tube down to the forehead there, making sure all the pressure

05:10points are checked. My blue towel is going to do most of the work here to keep the tube in place

05:15nice and tight. And that's pretty much it. Pretty straightforward nasal intubation there. I did have

05:21to use in the gills. It's always a chink in the armor there when you have to use in the gills. But you have

05:26to do what you got to do, especially when you're by yourself. You have to make sure you plan for all

05:31scenarios. I always have plan B, C, and D in the back of my head if things go south. And we go from

05:38there. The patient did really well. This was an awesome, awesome case. And I will be sharing more

05:43videos with you as they come. Thank you for watching.

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