Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, 100000, China.
BMC Anesthesiol. 2022 Nov 24;22(1):360. doi: 10.1186/s12871-022-01910-3.
Patients undergoing oral and maxillofacial surgeries under general anesthesia usually require nasotracheal intubation. When presented with patients with equally patent nostrils, selection of the nostril to use for intubation is an important decision for facilitating intubation. The objective of this trial is to determine whether choice of nostril impacts nasotracheal intubation when using a video rigid stylet in patients undergoing oral and maxillofacial surgery.
Fifty patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly allocated into two groups to undergo nasotracheal intubation through the left nostril (Group L, n = 25) or the right nostril (Group R, n = 25). Intubation was performed by experienced anesthesiologists using a video rigid stylet. The primary endpoint was time to successful intubation, which was defined as the duration from when the tip of the stylet-tube assembly entered the selected nostril to when the tube entered the trachea. Secondary outcomes included: length of time for device insertion; length of time for tube insertion; total success rate; first-attempt success rate; number of intubation attempts; requirement of airway assisted maneuvers; incidence and severity of epistaxis. Intubation-related adverse events were monitored for up to postoperative 24 h.
Median time (interquartile range) to tracheal intubation was 25.3 seconds (20.7 to 27.6) in Group L and 26.8 seconds (22.5 to 30.0) in Group R (median difference (MD) = 1.9; 95% confidence interval (CI) -1.8 to 5.7, P = 0.248). Nasotracheal intubation was successful in all patients in both groups and the first-attempt success rates in both groups were similar (Group L: 96% (24/25); Group R: 96% (24/25); relative risk (RR) 1.0; 95% CI 0.9 to 1.1; P > 0.999). No significant difference of requirement of assisted maneuvers was noted between the two groups (Group L: 36% (9/25); Group R: 28% (7/25); RR 0.8; 95% CI 0.3-1.8; P = 0.544). Furthermore, all patients showed a high quality of visualization of the glottis (Cormack and Lehane Grade I). For safety outcomes, the incidence and severity of epistaxis during intubation was comparable between the two groups. There were no significant differences between the selection of nostrils and intubation-related adverse events up to 24 h after surgery.
When considering which nostril to use for intubation with video rigid stylet, either nostril can be used similarly.
Clinicaltrials.gov . Identifier: NCT05218590.
接受全身麻醉下口腔颌面手术的患者通常需要经鼻气管插管。当患者的两个鼻孔同样通畅时，选择用于插管的鼻孔是方便插管的重要决策。本试验的目的是确定在使用视频刚性探条进行口腔颌面手术的患者中，选择鼻孔是否会影响经鼻气管插管。
50 名计划接受择期口腔颌面手术并需要经鼻气管插管的患者被随机分配到两组，分别通过左鼻孔（L 组，n=25）或右鼻孔（R 组，n=25）进行经鼻气管插管。由经验丰富的麻醉师使用视频刚性探条进行插管。主要终点是成功插管的时间，定义为探条-管组件尖端进入所选鼻孔到管进入气管的时间。次要结果包括：器械插入时间；管插入时间；总成功率；首次尝试成功率；插管尝试次数；需要气道辅助操作；鼻出血的发生率和严重程度。监测与插管相关的不良事件，直到术后 24 小时。
L 组插管至气管的中位时间（四分位距）为 25.3 秒（20.7 至 27.6），R 组为 26.8 秒（22.5 至 30.0）（中位数差（MD）=1.9；95%置信区间（CI）-1.8 至 5.7，P=0.248）。两组患者均成功进行了经鼻气管插管，且两组的首次尝试成功率相似（L 组：96%（24/25）；R 组：96%（24/25）；相对风险（RR）1.0；95%CI 0.9 至 1.1；P＞0.999）。两组患者需要气道辅助操作的比例无显著差异（L 组：36%（9/25）；R 组：28%（7/25）；RR 0.8；95%CI 0.3 至 1.8；P=0.544）。此外，所有患者的声门显示质量均为高（Cormack 和 Lehane 分级 I）。在安全性结果方面，两组患者插管期间鼻出血的发生率和严重程度相似。直到术后 24 小时，鼻孔选择和与插管相关的不良事件之间均无显著差异。
在使用视频刚性探条时，考虑使用哪个鼻孔进行插管，两个鼻孔均可使用。
Clinicaltrials.gov。标识符：NCT05218590。
