Vadhanan Prasanna, Tripaty Debendra Kumar
Department of Anaesthesia, Vinayaka Missions Medical College, Karaikal, Puducherry, India.
Department of Anaesthesiology and Critical Care, Indra Gandhi Government Medical College and Research Centre, Puducherry, India.
Turk J Anaesthesiol Reanim. 2018 Apr;46(2):96-99. doi: 10.5152/TJAR.2017.51333. Epub 2017 Nov 27.
Bleeding due to inadvertent trauma is a troublesome complication of nasal intubations. A lot of methods have been suggested to minimise this problem. A flexible bougie can be passed atraumatically via the nasal route to the trachea and an appropriate-sized endotracheal tube can be railroaded over it to avoid this problem. The primary objective of the study was to compare the severity of bleeding with bougie-guided and conventional nasotracheal intubations on a subjective scale. The time taken for successful intubations and the number of attempts required were also noted.
This randomised controlled study was performed in 40 adult patients requiring nasotracheal intubations for various elective surgeries over a 3-month period in a teaching hospital. The patients after satisfying the inclusion criteria were randomised into two groups of 20 each: Bougie-guided (Group B) and Not Bougie-guided (Group NB). Group B patients were intubated by railroading the endotracheal tube over a flexible bougie, and Group NB patients were intubated conventionally without the bougie. The degree of bleeding was noted on a subjective scale as nil, mild, moderate or severe. The time taken for intubation in seconds and the number of attempts taken were noted. The degree of bleeding was compared using Mann-Whitney U test, and the time taken for intubation was compared using the Student's t test after assessing normalcy. An alpha error of 5% was used, and p values less than 0.05% were considered significant.
All patients randomised completed the study. The degree of bleeding was lesser in the Bougie-guided group than in the conventional group (p=0.02), and the time taken for intubation was longer in the bougie-guided group (p<0.01).
Using a bougie routinely for nasal intubations might minimise trauma during nasal intubations but increase the time taken for intubation marginally. The success rates for intubations may also be better.
因意外创伤导致的出血是鼻腔插管的一个棘手并发症。人们提出了许多方法来尽量减少这个问题。一根可弯曲探条可经鼻腔无创伤地插入气管，然后可将合适尺寸的气管内导管沿其推送过去，以避免这个问题。本研究的主要目的是在主观量表上比较使用探条引导的鼻腔气管插管和传统鼻腔气管插管的出血严重程度。同时记录成功插管所需的时间和尝试次数。
这项随机对照研究在一家教学医院对40例因各种择期手术需要进行鼻腔气管插管的成年患者进行，为期3个月。符合纳入标准的患者被随机分为两组，每组20例：探条引导组（B组）和非探条引导组（NB组）。B组患者通过将气管内导管沿一根可弯曲探条推送进行插管，NB组患者则采用传统方式不使用探条进行插管。出血程度按主观量表记录为无、轻度、中度或重度。记录插管所用的时间（秒）和尝试次数。使用曼-惠特尼U检验比较出血程度，在评估数据呈正态分布后，使用学生t检验比较插管所用时间。采用5%的α错误率，p值小于0.05被认为具有统计学意义。
所有随机分组的患者均完成了研究。探条引导组的出血程度低于传统组（p = 0.02），且探条引导组的插管时间更长（p < 0.01）。
常规使用探条进行鼻腔插管可能会使鼻腔插管过程中的创伤最小化，但会略微增加插管时间。插管成功率可能也会更高。
