Epistaxis During Nasotracheal Intubation: A Comparison of Nostril Sides

Analysis of clinical characteristics, dental treatment performed, and postoperative complications of 200 patients treated under general anesthesia in a special needs dental clinic in northern Taiwan

“…Direct compression may be difficult for special needs patients after recovery from anesthesia, and the matter becomes even more complicated if patients have difficulty swallowing. Methods to reduce nasal bleeding rate including warming endotracheal tubes, 6 Xylometazoline pretreatment, 7 using the right nostril as the first choice, 8 and using a curved tip catheter as guidance. 9 As it is impossible to totally avoid epistaxis, the nasotracheal intubation should be avoided in patients who have bleeding tendencies.…”

Reliability of assessment of nasal flow rate for nostril selection during nasotracheal intubation

“…In the vast majority of adults, tubes with an ID of 7.0 to 7.5 mm pass easily through the nostril [13]. Many studies of the incidence of epistaxis during nasotracheal intubation used 6.0 or 6.5 mm for women and 6.5 or 7.0 mm for men [11,[14][15][16]. The reinforced tube used in this study was made of soft, flexible polyvinyl chloride with spiral reinforcing wire.…”

“…However, the right nostril is recommended if both nostrils offer equal resistance, because the bevel of the tube passes the vocal cords more easily when introduced through the right nostril [13]. Sanuki et al [16] reported that epistaxis occurred more frequently (44.4%) with the left nostril than the right nostril (11.1%). They concluded that the right nostril should be used if patency is the same for both nostrils.…”

Complications of Airway ManagementDiscussion

“…Coe and Human 30 found no significant difference in bleeding based on nostril side. Sanuki et al 31 documented the left nostril as being more prone to severe epistaxis (22% (left) vs 0% (right), P Ͻ .02). The left side might be injured more frequently because the beveled tip of the ETT faces the left side and impacts the more vascular mucosa of the turbinates.…”