Softened endothracheal tube reduces the incidence and severity of epistaxis following nasotracheal intubation.

Abstract

Many complications were reported to be related with nasotracheal intubation. Various chemical or mechanical techniques have been proposed to decrease hemorrhage and trauma associated with nasotracheal intubation but the results remain controversial. We conducted a prospective, randomized, single-blind study to elucidate the effect of an endotracheal tube softened with warm water before use on the incidence and severity of epistaxis following nasotracheal intubation. Sixty-two healthy, (ASA class I or II) patients scheduled for elective surgery were randomly assigned into two groups. Patients in the treatment group were intubated with a softened endotracheal tube made possible by heating it in warm water while those in the control group were intubated with unsoftened (intact) tube. Epistaxis was evaluated immediately after intubation and its severity was graded as none, mild, moderate and severe. The use of Magill forceps and postoperative nasal morbidity were also recorded. The total incidence of epistaxis in the "unsoftened" group was significantly higher than that of "softened" group (76.7% vs. 43.8%, P = 0.0002). The severity of nasal hemorrhage was also significantly lightened in the "softened" group. No technical difficulty was encountered in intubation with a softened endotracheal tube by prewarming. The morbidity referable to nasal intubation, however, did not differ in both groups. In conclusion, our study shows that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during the act of nasotracheal intubation. It is an effective way and worth a try.