Comparison Among Three Different Video Scope Guided Nasotracheal Intubation.

Comparison Among Three Different Video Scope Guided Nasotracheal Intubation: a Prospective, Non-randomised Controlled Trial

Nasotracheal intubation (NTI) has become the most optimal alternative to oral endotracheal intubation for oro-maxillofacial surgery because it can offer an excellent vision field of the mouth. Additional benefits include milder oropharynx stimulation, less airway secretions, and better tolerance for long term endotracheal intubation maintenance. Traditional NTI is performed under the guidance of indirect laryngoscope, which is often accompanied by longer maneuver time and adverse complications such as trauma and bleeding. The development of various visualization tools such as video laryngoscope, video fiberoptic scope and video rigid laryngoscope has greatly improved NTI. However, there is no consensus on which one is the best adjunctive device for NTI. Therefore, a study on a comparison of the clinical efficacy of the above three video scope guided methods for NTI will be conducted.

A total of 60 eligible patients will be enrolled in this prospective study, they are scheduled to undergo elective oro-maxillofacial surgeries under general anaesthesia with nasotracheal intubation in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. According to the kinds of video methods uesd to assist in nasotracheal intubation, patients will be randomly divided into video laryngoscope group, video fiberoptic scope group and video rigid laryngoscope group, 20 participants in each group. The data of the duration of catheter reaching oropharynx (T1), the duration of catheter reaching glottis (T2), successful intubation time (T3), the first-attempt intubation success rate, the total number of intubations for each participant, whether there is oral and nasal mucosa bleeding, whether the tracheal ring is pressed, whether the catheter is rotated, the heraodynamic changes, and the occurrence of throat complications within 2 hours after surgery, will be recorded respectively.

Inclusion Criteria:

1. Participants scheduled for elective oro-maxillofacial surgery under general anesthesia.
2. Age between 18 and 65 years old.
3. The American Society of Anesthesiologists (ASA) Ⅰ～Ⅱ.
4. Body mass index (BMI) 18.5～24.9kg/m2.
5. Mallampati Ⅰ～Ⅱ.
6. Able to give informed consent.

Exclusion Criteria:

1. Participants with severe intranasal diseases.
2. Participants with severe and uncontrolled clotting diseases.
3. Participants with skull base fractures and cerebrospinal fluid leakage.
4. Participants with unstable cardiovascular and cerebrovascular diseases, or with poor tolerance to vagal stimulation.
5. Participants who are deemed ineligible for participation in the clinical trial by the investigator.
6. Participants who have to receive the alternative therapy to establish ventilation after the several attempts for nasotracheal intubation.