Park Jun-Young, Yu Jihion, Kim Chan-Sik, Mun Taeho, Jeong Woo Shik, Choi Jong Woo, Lee Kichang, Kim Young-Kug
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2024 Dec;77(6):596-604. doi: 10.4097/kja.24337. Epub 2024 Aug 21.
The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril.
Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy.
The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group.
The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.
经左鼻孔进行鼻气管插管时鼻出血的发生率高于经右鼻孔插管。本研究评估了鼻气管导管的反向斜面和尖端方向对经左鼻孔进行鼻气管插管时鼻出血发生率的影响。
接受右侧颌面外科手术且需要经左鼻孔进行鼻气管插管的患者被随机分配至对照组（气管导管为常规方向）或反向组（180˚反向，导管斜面朝向鼻中隔且斜面的前缘（即尖端）背离鼻中隔）（每组n = 37）。主要结局是使用视频喉镜评估的鼻出血发生率。
反向组鼻出血的发生率显著低于对照组（9例[24.3%]对20例[54.1%]，P = 0.009；相对危险度：0.45，95%可信区间[0.24, 0.85]，绝对危险度降低：29.8%，需治疗人数：3）。反向组鼻出血的严重程度显著更低（P = 0.002）。反向组首次尝试通过鼻腔的成功率显著更高（P = 0.027）。反向组术后鼻痛更低（P < 0.001），患者满意度更高（P < 0.001）。两组均未发生与鼻气管导管相关的并发症。
鼻气管导管的反向斜面和尖端方向降低了经左鼻孔进行鼻气管插管患者鼻出血的发生率和严重程度，并提高了患者满意度。
