Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial

Abstract

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

Cuff inflation technique is better than Magill forceps technique to facilitate nasotracheal intubation guiding by GlideScope® video laryngoscope

“…In our study, our recommended technique presents a common and simple skill for intubators without head movement and external laryngeal manipulation without needed use of a soft ivory PVC nasotracheal tube. Another study where patients had a pillow positioned below the head while using GlideScope® video laryngoscope‐assisted nasotracheal intubation with nasal Ring–Adair–Elwin tracheal tubes (Mallinckrodt Medical, Covidien, Dublin, Ireland) revealed that 50% of patients required Magill forceps to optimize the maneuver 16 . Our design is presented similar to Kang et al 16 where the head of the patient was placed in a neutral position on a pillow with flexed neck but without changing position such as over‐flexing the neck or turning the neck to the side during tube advancement, and no external laryngeal pressure.…”

“…T A B L E 3 (Continued) Although the study revealed that patients needing auxiliary techniques (Magill forceps or cuff inflation) were 56.7% in the Magill forceps group and 50% in the cuff inflation group, respectively, in other studies, the incidence of using auxiliary techniques is up to 50%. 5,13,15,16 Jones et al reported that using a Portex Polar Preformed Nasotracheal tube with GlideScope ® video laryngoscope and a combination of sophisticated techniques with external laryngeal manipulation and change in head position of the patient enables successful nasotracheal intubation without Magill forceps. 13 In our study, our recommended technique presents a common and simple skill for intubators without head movement and external laryngeal manipulation without needed use of a soft ivory PVC nasotracheal tube.…”