Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial

Sato, Aiji; Hanamoto, Hiroshi; Hirose, Yoshiaki; Kudo, Chiho; Morimoto, Yoshinari; Sugimura, Mistutaka; Niwa, Hitoshi

doi:10.1016/j.jclinane.2014.01.016

Cited by 29 publications

(42 citation statements)

References 13 publications

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“…First, data have shown that less epistaxis occurred during NTI and intubation was faster in the right than in the left nostril, an effect related to the anatomy of structures located on the posterior nasopharyngeal wall; thus, the right nostril should be chosen if patency appears to be equal on both sides of the nose [1,11,12]. It was also reported that measurement of the nasal flow rate is a useful clinical method for choosing which nostril to use for NTI [13].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

Preprint

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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 fiberoptic bronchoscopy. Methods Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fiberoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time were recorded. Epistaxis was recorded using direct laryngoscopy ﬁve minutes after completing NTI. Results The time to complete NTI was significantly longer in the fiberoptic group than the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% CI, 10.4 to 18.1). In addition, Mild epistaxis (nasal bleeding) was observed in 8 patients in the fiberoptic group and 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, there was no obvious nasal pain at any time point after extubation in the Disposcope group, and there was no significant difference between the two groups. Conclusion NTI can be completed successfully using either fiberoptic bronchoscopy or a Disposcope endoscope as a guide without any severe adverse reactions. However, compared to fiberoptic bronchoscopy, the Disposcope endoscope requires less transaction time.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

Preprint

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“…Magill forceps were also used as required during intubation. In this study, after verifying the absence of rhinostenosis at the time of the preoperative examination and the preoperative CT scan, nasotracheal intubation was performed through the right nasal cavity in all patients [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

The usefulness of the McGrath MAC laryngoscope in comparison with Airwayscope and Macintosh laryngoscope during routine nasotracheal intubation: a randomaized controlled trial

et al. 2017

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BackgroundMcGrath MAC video laryngoscope offers excellent laryngosopic views and increases the success rate of orotracheal intubation in some cases. The aim of this study was to determine the usefulness of McGrath MAC for routine nasotracheal intubation by comparing McGrath MAC with Airway scope and Macintosh laryngoscope.MethodsA total of 60 adult patients with ASA physical status class 1 or 2, aged 20–70 years were enrolled in this study. Patients were scheduled for elective oral surgery under general anesthesia with nasotracheal intubation. Exclusion criteria included lack of consent and expected difficult airway. Patients were randomly allocated to three groups: McGrath MAC (n = 20), Airway scope (n = 20), and Macintosh laryngoscope (n = 20). After induction, nasotracheal intubation was performed by six expert anesthesiologists with more than 6 years of experience.ResultsThere were no significant differences in preoperative airway assessment among the three groups. Successful tracheal intubation time was 26.8 ± 5.7 (mean ± standard deviation) s for McGrath MAC, 36.4 ± 11.0 s for Airway scope, and 36.5 ± 8.9 s for Macintosh laryngoscope groups. The time for successful tracheal intubation for McGrath MAC group was significantly shorter than that for Airway scope and Macintosh laryngoscope (p < 0.01). McGrath MAC significantly improved the Cormack Lehane grade for nasotracheal intubation compared with Macintosh laryngoscope (p < 0.05).ConclusionMcGrath MAC significantly facilitates routine nasotracheal intubation compared with Airwayscope and Macintosh laryngoscope by shortening the tracheal intubation time and improving the Cormack Lehane grade.Trial registrationUMINCTR Registration number UMIN000023506. Registered 5 Aug 2016.

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“…Previous studies have discussed many strategies to reduce the risk of epistaxis during NTI in clinical practice. First, data have shown that less epistaxis occurred during NTI and intubation was faster in the right rather than the left nostril, which is related to the anatomy of the structures located on the posterior nasopharyngeal wall; thus, the right nostril should be selected if patency appears to be equal on both sides of the nose [1,12,13]. Measurement of the nasal flow rate has also been reported to be a useful clinical method for selecting which nostril to use for NTI [14].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

Preprint

View full text Add to dashboard Cite

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).

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Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial

Cited by 29 publications

References 13 publications

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

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

The usefulness of the McGrath MAC laryngoscope in comparison with Airwayscope and Macintosh laryngoscope during routine nasotracheal intubation: a randomaized controlled trial

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

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