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The goal of this prospective randomized study is to compare the effect of nasal tip lifting during nasotracheal intubation.
The question the investigators are trying to answer is: If the nasal tip is tilted, will the E-tube be more likely to enter the lower passage during nasal intubation?
There are three nasal turbinates inside the nasal cavities. Each nasal cavity is divided into four spaces from these nasal turbinates, but the two spaces separated by the upper nasal turbinate are too narrow to be clinically meaningful. So when performing nasotracheal intubation, the tube enters one of the two spaces in low part divided into the lower turbinate. The middle turbinate, unlike others, a large number of blood vessels and nerves are distributed. Therefore, less hemorrhage might occurs when the tracheal tube enters into the lower pathway below the lower turbinate because the tube would not scratching the middle turbinate.
The hypothesis of this study is that the method 'sniffing position and nasal tip lifting' increases possibility to enter into lower pathway when the tube enters the nasal cavity. The purpose of a present study was to investigate the effect of 'sniffing position & nose' on the intranasal route of the tube.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional | Active Comparator | Performed nasotracheal intubation as usual. Sniffing position but doesn't lift a nasal tip. |
|
| Nasal tip lifting | Experimental | Performed sniffing position and nasal tip lifting while the endotracheal tube insert patient's nasal cavity. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sniffing position | Procedure | All procedure is done under sniffing position. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with nasal endotraheal tube in the lowest nasal pathway. | After the endotracheal intubation is completed, the experimenter confirms by a fiberoptic bronchoscope which path the endotracheal tube is located. | Through study completion, an average of 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Nasal bleeding | After nasotracheal intubation, the researcher confirm there is nasal bleeding or not. And if bleeding observed, the experimenter would check the amount. | Through study completion, an average of 1 year |
| Intubation time |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jung-Man Lee, M.D.,PhD | Seoul National University Boramae Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Boramae Hospital | Seoul | 07061 | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18083994 | Background | Ahmed-Nusrath A, Tong JL, Smith JE. Pathways through the nose for nasal intubation: a comparison of three endotracheal tubes. Br J Anaesth. 2008 Feb;100(2):269-74. doi: 10.1093/bja/aem350. Epub 2007 Dec 14. | |
| 16866113 | Background | Patiar S, Ho EC, Herdman RC. Partial middle turbinectomy by nasotracheal intubation. Ear Nose Throat J. 2006 Jun;85(6):380, 382-3. |
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| Nasal tip lifting | Procedure | Before inserting the endotracheal tube to patient's nose, the researcher lift up the nose tip. |
|
Check the time from initiation of insertion of E-tube to finish passing nasal path and to finish intubation.
| Through study completion, an average of 1 year |
| 10360881 | Background | Williams AR, Burt N, Warren T. Accidental middle turbinectomy: a complication of nasal intubation. Anesthesiology. 1999 Jun;90(6):1782-4. doi: 10.1097/00000542-199906000-00039. No abstract available. |
| 9241346 | Background | Dost P, Armbruster W. Nasal turbinate dislocation caused by nasotracheal intubation. Acta Anaesthesiol Scand. 1997 Jun;41(6):795-6. doi: 10.1111/j.1399-6576.1997.tb04787.x. |
| 6614546 | Background | Scamman FL, Babin RW. An unusual complication of nasotracheal intubation. Anesthesiology. 1983 Oct;59(4):352-3. doi: 10.1097/00000542-198310000-00016. No abstract available. |
| 30044295 | Derived | Kim H, Lee JM, Lee J, Hwang JY, Chang JE, No HJ, Won D, Choi S, Min SW. Influence of Nasal Tip Lifting on the Incidence of the Tracheal Tube Pathway Passing Through the Nostril During Nasotracheal Intubation: A Randomized Controlled Trial. Anesth Analg. 2018 Dec;127(6):1421-1426. doi: 10.1213/ANE.0000000000003673. |