Which condition is a contraindication for nasotracheal intubation?

• A. Apnea
• B. Epistaxis
• C. Coagulopathy
• D. Nasal obstruction

Answer: (A)

When you’re securing an airway, keeping oxygen flowing is the top priority. Nasotracheal intubation relies on passing a tube through the nasal passage, and if the patient is apneic, there’s no spontaneous breathing to help maintain oxygenation during the procedure. Any delay or difficulty in placing the tube can quickly lead to desaturation, so performing a nasal route in an apneic patient is contraindicated. The safer approach is to secure the airway with a method that ensures reliable ventilation, such as orotracheal intubation during a controlled induction. Other nasal-route concerns, like nasal obstruction, coagulopathy, or active epistaxis, raise bleeding or passage risks but don’t capture the immediate ventilation danger that apnea introduces.