My opinion

By Dr. Deepak Gupta , Dr. Mohamed Ismaeil
Corresponding Author Dr. Deepak Gupta
Wayne State University, - United States of America
Submitting Author Dr. Deepak Gupta
Other Authors Dr. Mohamed Ismaeil
Detroit Medical Center, Anesthesiology, - United States of America


Double Barrel Nasopharyngeal Airway, Mouth Opening

Gupta D, Ismaeil M. Double Barrel Nasopharyngeal Airway Ventilation When Mouth Is Not Opening. WebmedCentral ANAESTHESIA 2022;13(12):WMC005808

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 20 Nov 2022 10:22:22 PM GMT
Published on: 05 Dec 2022 12:39:25 AM GMT

My opinion

For spontaneous, manual and mechanical ventilation when patient's mouth is not opening as anticipated during elective anesthesia scenarios like maxilla-mandibular fixation or facial flap and during emergent anesthesia scenarios like unanticipated masseter spasm, double barrel nasopharyngeal airway (NPA) [1] to keep nasal cavities and pharyngeal cavity open with proximal end-tidal capnography (EtCO2) continuously monitoring adequacy of ventilation may come in handy [2]. This has been independently conceived by us de novo and oblivious to pre-existing publication [3]. Manual and mechanical ventilation may be feasible with double lumen tube (DLT) connector connected to double barrel NPA via two universal 15 mm connectors appropriately sized to fit two NPAs being used as double barrel NPA. With DLT connector-based ventilation via double barrel NPA, neither nostril will need to be apposed to prevent air leak during manual and mechanical ventilation; moreover, individual NPAs can be independently suctioned as if suctioning DLT. If not using double barrel NPA, single NPA with contralateral nostril apposed can allow manual and mechanical ventilation via single NPA connected to appropriate size single universal 15 mm connector. In spontaneously ventilating patient, either nasal prongs inside double barrel NPA for continuous oxygen supplementation with integrated nasal EtCO2 sampling line [4], or T-piece on one NPA via universal 15 mm connector plus sidestream EtCO2 airway adapter with contralateral NPA open to air can be safe bet to keep airway open, supplement oxygenation and monitor ventilation concurrently and effectively. Therefore, manufacturers of NPA should consider packaging universal 15 mm connectors with their NPAs while manufacturers of DLT should consider independently packaged DLT connectors for use with double barrel NPAs. 


  1. YouTube. Double Barrel Nasopharyngeal Airway Ventilation If Mouth Isn't Opening| Deepak Gupta|Mohamed Ismaeil.
  2. Camacho M, Wei JM, Reckley LK, Song SA: Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery. Anesthesiol Res Pract 2018;2018:8567516 
  3. Yoon U, Yuan I: Modified Nasal Trumpet for Airway Management. Anesthesiology 2016;125:596
  4. Restrepo RD, Karpenkop I, Liu KE: Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor. J Vis Exp 2020;(163):10.3791/61670

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