Shohara Ken, Goto Tomoko, Kuwahara Goro, Isakari Yoshitoyo, Moriya Tomomi, Yamamuro Tukasa
Department of Dentistry and Maxillofacial Surgery, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan.
Department of Anesthesiology, Itoh Dento-Maxillofacial Hospital, 4-14 Kokaihonmachi, Kumamoto, 860-0851, Japan.
J Anesth. 2017 Feb;31(1):1-4. doi: 10.1007/s00540-016-2262-6. Epub 2016 Oct 13.
Numerous techniques have been used to reduce epistaxis during nasotracheal intubation. Rhinometry can assess nasal patency in preoperative conditions. However, the possible role of rhinometry in routine nasotracheal intubation has not been studied.
One hundred and one patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. We examined whether symmetry or any asymmetry in bilateral airflow patterns by condensation of the expiration, assessed by preoperative rhinometry on seated position, increased the incidence of epistaxis and the need for a nasogastric catheter to guide the endotracheal tube into the oropharynx. We also compared the incidence of changing the site of nasal intubation between the assessment by rhinometry and by cone-beam computed tomography analysis of nasal airspace in the inferior meatus.
Patients with any asymmetry in bilateral airflow patterns were 18 % (n = 18), the remaining 82 % (n = 83) had symmetric bilateral nasal cavities. Patients with any asymmetry were more likely to need a guiding nasogastric catheter than patients with symmetry (22 vs. 3.6 %, p = 0.018). The incidence of epistaxis was higher in patients with any asymmetry (39 %) than those with symmetry (16 %), but there was no significant difference between groups (p = 0.055). The site of intubation was changed more frequently based on cone-beam computed tomography analysis than by rhinometry (38 vs. 11 %, p = 0.043).
Preoperative rhinometry may be a valuable objective tool to assess nasal patency for nasotracheal intubation in patients who undergo dental and maxillofacial surgery.
已采用多种技术来减少鼻气管插管期间的鼻出血。鼻阻力测量法可在术前评估鼻腔通畅性。然而，鼻阻力测量法在常规鼻气管插管中的潜在作用尚未得到研究。
纳入101例需要全身麻醉和鼻气管插管的口腔颌面外科手术患者。我们通过坐位时术前鼻阻力测量法评估呼气冷凝形成的双侧气流模式是否对称或存在任何不对称，这是否会增加鼻出血的发生率以及是否需要鼻胃管将气管导管引导至口咽。我们还比较了鼻阻力测量法评估与鼻道鼻窦锥形束计算机断层扫描分析之间鼻插管部位改变的发生率。
双侧气流模式存在任何不对称的患者为18%（n = 18），其余82%（n = 83）双侧鼻腔对称。与对称患者相比，存在任何不对称的患者更有可能需要引导性鼻胃管（22%对3.6%，p = 0.018）。存在任何不对称的患者鼻出血发生率（39%）高于对称患者（16%），但两组之间无显著差异（p = 0.055）。基于锥形束计算机断层扫描分析的插管部位改变比鼻阻力测量法更频繁（38%对11%，p = 0.043）。
术前鼻阻力测量法可能是评估口腔颌面外科手术患者鼻气管插管鼻腔通畅性的一种有价值的客观工具。
