Abstract
Background Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient's own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation.
Highlights
Nasotracheal intubation is one of the most common methods for established airway management in patients undergoing surgeries, especially in the head and neck region
Qualitative variables are presented as proportions, whereas quantitative variables are expressed as means and standard deviation. e nasal endoscopic examination was considered as the “gold standard” test for determining the patency of the nostril. e diagnostic value of each simple method was calculated using STATA version 10.0
Epistaxis was observed in 69.05% of cases, with mild bleeding. is epistaxis complication was not statistically significantly different between the right and left nostril (p value > 0.05) (Table 3)
Summary
Nasotracheal intubation is one of the most common methods for established airway management in patients undergoing surgeries, especially in the head and neck region. Rhinomanometry has been introduced to evaluate the patency of nostrils [13,14,15] This method is not commonly used in clinical practice because it is not simple and requires special equipment; simpler techniques are preferred. Proposed simple methods include examining the pattern of condensation from expired breath on a spatula [16], inspecting the caudal end of the nasal septum [16], palpating the airflow from each nasal passage [17], and conducting a preanesthetic interview during which the patient is asked which one they perceive to be the clearer nostril [17, 18]. Is study was developed to compare the reliability of simple clinical assessment of the patency of nostrils with results from nasal endoscopic examination. Combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation
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