Abstract
BackgroundNasotracheal intubation (NTI) is frequently performed for oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy.MethodsSixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. The NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was evaluated by direct laryngoscopy five minutes after completing NTI and was scored as one of four grades according to the following modified criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis.ResultsThe time to complete NTI was significantly longer in the fibreoptic group than in the Disposcope group (38.4 s vs 24.1 s; mean difference, 14.2 s; 95% confidence interval (CI), 10.4 to 18.1). Mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9), though no moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported by any of the patients at any time point after extubation (P = 0.74).ConclusionNTI can be completed successfully using either fibreoptic bronchoscopy or Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, Disposcope endoscope requires less execution time (the NTI time).Trial registrationThis clinical research was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPR-17011462, date of registration, May 2017).
Highlights
Nasotracheal intubation (NTI) is frequently performed for oral and maxillofacial surgeries
In a pilot study (5 patients in each group intubated by a trained anaesthesiologist who was familiar with both techniques) prior to this research, the NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was significantly longer in the fibreoptic group than in the Disposcope group (43.0 ± 13.4 s vs 24.0 ± 3.2 s)
No significant differences were identified between the groups with regard to patient age, height, weight, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, Mallampati score, sex ratio or duration of tracheal tube indwelling time (Table 1)
Summary
Nasotracheal intubation (NTI) is frequently performed for oral and maxillofacial surgeries. Nasotracheal intubation (NTI) is frequently used during oral and maxillofacial surgeries [1], and possible complications, especially epistaxis and trauma to the airway, can occur [2]. Fibreoptic bronchoscopy-guided NTI is associated with less epistaxis and better navigability and. Compared to the Macintosh laryngoscope, the Disposcope endoscope yields a higher success rate for endotracheal intubation and provides a better view of the glottis; it is associated with a shorter intubation time and causes fewer dental injuries when used to imitate intubation on a manikin wearing a semi-rigid neck collar [6]. The Disposcope endoscope demonstrated a promising ability to guide successful endotracheal intubation in trauma patients wearing a semi-rigid neck collar [6]. Another study showed that the Disposcope endoscope can be applied successfully in double-lumen tube placement [7]
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