A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

Abstract

Background: Nasotracheal intubation (NTI) is frequently performed in oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy. Methods: Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was recorded using direct laryngoscopy five minutes after completing NTI and was scored as one of four grades according to the following modified criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis. Results: The time to complete NTI was significantly longer in the fibreoptic group than that in the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% confidence interval (CI), 10.4 to 18.1). In addition, mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9). No moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported at any time point after extubation in the two groups (P = 0.74). Conclusion: NTI can be completed successfully using either fibreoptic bronchoscopy or a Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, the Disposcope endoscope requires less execution time (the NTI time).