Does a Warm Tube Improve Nasotracheal Intubation?

Warming the endotracheal tube (ETT) is widely believed to increase success and decrease complications related to nasotracheal intubation. Some anesthetists also have advocated use of an obturator to partially occlude the distal end of the ETT and reduce the likelihood of upper airway trauma. Investigators in Korea randomized 200 healthy oral surgery patients without difficult airway attributes to undergo nasotracheal intubation under one of four conditions: ETT at room temperature (group 1), ETT at room temperature with obturator in place (group 2), ETT warmed to 40°C (group 3), or ETT warmed to 40°C with obturator in place (group 4).

General anesthesia was induced with patients in the supine position, and nasotracheal intubation was perform…