From the Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea (DW, HK, JEC, JML, SWM, JYH, TKK), Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (JJ, HJY).
Eur J Anaesthesiol. 2021 Feb 1;38(2):157-163. doi: 10.1097/EJA.0000000000001347.
For nasotracheal intubation, the nasal pathway between the inferior turbinate and hard palate (lower pathway) is preferred for patient safety. However, selecting the lower pathway can be challenging because passage of the tube through the nasal pathway is usually performed blindly.
We investigated whether facing the bevel of the tracheal tube in the cephalad direction of the patient could help in advancing the tracheal tube through the lower pathway during nasotracheal intubation.
A randomised, blinded trial.
SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea from January 2019 to March 2020.
Sixty-eight adult patients undergoing oromaxillary surgeries were enrolled in this study.
Patients were randomly allocated to undergo nasotracheal intubation with the bevel of the tube facing the cephalad direction (intervention group) or to the left (conventional group).
The effects of bevel direction on the pathway of the tube in the nasal cavity, and the incidence of epistaxis were evaluated by fibreoptic bronchoscopy.
The success rate of the tracheal tube passing through the lower pathway was significantly higher in the intervention group than the conventional group (79.4 vs. 55.9%, relative risk 1.421, 95% CI 1.007 to 2.005, P = 0.038). The incidence of epistaxis was also lower in the intervention group than in the conventional group (41.2 vs. 73.5%, relative risk 0.560, 95% CI 0.357 to 0.878, P = 0.007).
Facing the bevel of the tracheal tube in the cephalad direction of the patient facilitated selection of the lower pathway and reduced the incidence of epistaxis during nasotracheal intubation in patients undergoing oromaxillary surgery.
ClinicalTrial.gov, NCT03740620.
对于经鼻气管插管，下鼻甲和硬腭之间的鼻腔路径（下路径）更有利于患者安全。然而，选择下路径可能具有挑战性，因为通常是盲探将管通过鼻腔路径插入。
我们研究了将气管导管的斜面朝向患者头侧方向是否有助于经鼻气管插管时将气管导管推进下路径。
一项随机、盲法试验。
韩国首尔国立大学医学院 SMG-SNU 博雷马医学中心，2019 年 1 月至 2020 年 3 月。
纳入本研究的是 68 名接受口颌面手术的成年患者。
患者随机分为将管斜面朝向头侧（干预组）或左侧（常规组）进行经鼻气管插管。
纤维支气管镜评估管在鼻腔中的路径以及鼻出血的发生率。
干预组气管导管通过下路径的成功率明显高于常规组（79.4% vs. 55.9%，相对风险 1.421，95%置信区间 1.007 至 2.005，P=0.038）。干预组鼻出血的发生率也低于常规组（41.2% vs. 73.5%，相对风险 0.560，95%置信区间 0.357 至 0.878，P=0.007）。
在进行口颌面手术的患者中，将气管导管的斜面朝向患者头侧方向有助于选择下路径，并降低经鼻气管插管时鼻出血的发生率。
ClinicalTrials.gov，NCT03740620。
