Experience with nasotracheal intubation: Description of the procedure and outcomes

Abstract

Background: Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia. The procedure for intubation involves achieving neuromuscular blockade followed by passing the endotracheal tube (ETT) into the trachea. Objectives: Our hypothesis was that the nasopharyngeal passage of the endotracheal tube can be facilitated by the finger of a sterile glove acting as a pathfinder. Patients and Methods: We performed a randomized controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, the tip of the ETT was inserted into the finger of a sterile glove before the ETT was inserted into the more patent nostril. In the control group (n=40), the gloves finger was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter: 7.0 mm). In the intervention group (n=40), the finger of a sterile glove was kept in position. The tip of the endotracheal tube is inserted into the gloves finger. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx when the gloves finger was removed and intubation completed. Results: The pathfinder technique reduced the incidence (p<0.001), and severity (p = 0.001) of bleeding, decreased tube contamination with blood and mucus (p< 0.001), and diminished postoperative nasal pain (p=0.035). Conclusion: Our study results suggest that nasopharyngeal passage of the endotracheal tube can be facilitated by (a sterile gloves finger) acting as a pathfinder.