Does prior nasopharyngeal airway dilatation improve nasotracheal intubation with suction catheter guidance? A prospective randomized study

Background: Bleeding during nasotracheal intubation occurs in approximately 80% of cases, caused by injury to the turbinate or avulsion of the mucosa during the passage of the endotracheal tube (ETT).Anatomical variations and sudden changes in direction during the passage of the ETT aggravate the trauma.Among the mechanical and pharmacological methods described to minimize bleeding, the use of a soft malleable guide to railroad the ETT into the hypopharynx and the instillation of vasoconstrictor drops have been found to be effective.Studies comparing added dilation using a nasopharyngeal airway (NPA) dilator with a suction catheter guide are currently lacking.Thus, we hypothesized that the addition of serial dilation of the airway using an NPA over the suction catheter as a guide would improve navigability and minimize bleeding.Methods: American Society of Anesthesiologists grade 1 and 2 patients requiring nasotracheal intubation (NTI) were randomized into two groups.In group A, NTI was performed using a suction catheter as a guide, while in group B, NTI was performed using a suction catheter and additional dilation using NPA.Anesthesia was similar in both groups.Navigability, bleeding, and secondary outcomes (number of attempts, side attempts, use of external laryngeal manipulation and Magill forceps, time taken, and hemodynamic changes) were assessed.Results: Ninety patients were enrolled, with 43 and 47 in groups A and B, respectively.Although small improvements in navigability (P = 0.543) and bleeding (P = 0.453) were observed in group B, the differences were not statistically significant.Group B required significantly fewer external laryngeal maneuvers than group A (21 (48.8%) vs. 12 (25.5%),P = 0.022).No differences in the number of attempts, side attempts, time taken, Magill's forceps requirement, oxygen saturation (SPO 2 ), or hemodynamic changes were observed.Conclusion: NPA dilation resulted in improvements in navigability and bleeding.