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A randomized comparison of three intubation techniques/tube materials for nasotracheal intubation

Une comparaison randomisée de trois techniques d'intubation/matériaux de sondes pour l'intubation nasotrachéale

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Abstract

Purpose

We sought to compare three intubation methods using different intubation techniques/tube materials for tube advancement from the nasal cavity into the oral cavity during nasotracheal intubation.

Methods

We conducted a randomized clinical trial with adult patients scheduled to undergo elective surgery requiring nasotracheal intubation for general anesthesia. Participants were randomly allocated to a polyvinyl chloride (PVC) tube group (group P), PVC tube attached to a rubber catheter group (group PR), or velvet-soft PVC tube group (group V). Tracheal intubation was then performed based on group allocation. The primary outcome was the first-attempt success rate of tube advancement into the oral cavity; secondary outcomes included the time required for tube advancement into the oral cavity, total intubation time, and the incidence of epistaxis.

Results

A total of 149 patients were included in the study. The first-attempt success rate in group V (90%) was significantly higher than that in group P (58%) (odds ratio, 6.5; 95% confidence interval [CI], 2.2 to 19.2), but similar to that in group PR (100%). The mean (standard deviation) time required for tube advancement into the oral cavity was significantly shorter in group V (16 [13] sec) than in group PR [40 (10) sec; 95% CI of mean difference, 17 to 30] and group P (26 [16] sec; 95% CI of mean difference, 3 to 16). Total intubation time was longest in group PR. Epistaxis occurred the least in group V.

Conclusions

Among the three intubation techniques/tube materials for nasotracheal intubation, the velvet-soft PVC tube provided the highest first-attempt success rate, most expeditious advancement into the oral cavity, and lowest incidence of epistaxis.

Study registration

ClinicalTrials.gov (NCT04695444); first submitted 30 December 2020.

Résumé

Objectif

Nous avons cherché à comparer trois méthodes d’intubation utilisant différentes techniques d’intubation / matériaux de sondes pour l’avancement de la sonde de la cavité nasale dans la cavité buccale pendant l’intubation nasotrachéale.

Méthode

Des patient·es devant recevoir une intubation nasotrachéale ont été réparti·es au hasard dans un groupe avec sondes en polychlorure de vinyle (PVC) (groupe P), un groupe avec sondes en PVC attachées à un cathéter en caoutchouc (groupe PR) ou un groupe avec sondes en PVC doux comme du velours (groupe V). L’intubation trachéale a ensuite été réalisée en fonction de l’affectation du groupe. Le critère d’évaluation principal était le taux de réussite de la première tentative d’avancement de la sonde dans la cavité buccale; les critères d’évaluation secondaires comprenaient le temps nécessaire à l’avancement de la sonde dans la cavité buccale, la durée totale de l’intubation et l’incidence d’épistaxis.

Résultats

Au total, 149 patient·es ont été inclus·es dans l’étude. Le taux de réussite de l’intubation à la première tentative était significativement plus élevé dans le groupe V (90 %) que dans le groupe P (58 %) (rapport de cotes, 6,5; intervalle de confiance à 95 % [IC], 2,2 à 19,2), mais similaire à celui du groupe PR (100 %). Le temps moyen (écart type) nécessaire pour l’avancement de la sonde dans la cavité buccale était significativement plus court dans le groupe V (16 [13] sec) que dans le groupe PR (40 [10] sec; IC 95 % de la différence moyenne, 17 à 30) et dans le groupe P (26 [16] sec; IC 95 % de la différence moyenne, 3 à 16). La durée totale d’intubation était la plus longue dans le groupe PR. C’est dans le groupe V que l’épistaxis a été la moins fréquente.

Conclusion

Parmi les trois techniques d'intubation/matériaux de sonde pour l'intubation nasotrachéale, le tube en PVC doux comme du velours a fourni le taux de réussite de première tentative le plus élevé, l'avancement le plus rapide dans la cavité buccale et l'incidence d'épistaxis la plus faible.

Enregistrement de l’étude

ClinicalTrials.gov (NCT04695444); première soumission le 30 décembre 2020.

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Author contributions

Jiwon Lee helped design and conduct the study, collect, interpret, and analyze the data, write the manuscript, and revise the manuscript. Jung-Man Lee helped design the study, interpret and analyze the data, and write and revise the manuscript. Yon Hee Shim helped collect and interpret the data as well as write and revise the manuscript. Joung Goo Cho helped design the study, as well as write and revise the manuscript. Jimin Lee helped collect the data as well as write and revise the manuscript. Jae-Yol Lim helped conduct the study. Chul Ho Chang helped design the study, write and revise the manuscript, and supervise the study.

Acknowledgements

Sohee Oh, PhD (Medical Statistician, Department of Biostatistics in SMG-SNU Boramae Medical Center) helped with the statistical analysis for the study.

Disclosures

The authors declare that they have no conflict of interest.

Funding statement

This research received no financial support.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea

    Jiwon Lee MD, PhD & Yon Hee Shim MD, PhD

  2. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Jung-Man Lee MD, PhD

  3. Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea

    Joung Goo Cho MD, PhD & Jimin Lee MD

  4. Department of Otorhinolaryngology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea

    Jae-Yol Lim MD, PhD

  5. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea

    Chul Ho Chang MD, PhD

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Lee, J., Lee, JM., Shim, Y.H. et al. A randomized comparison of three intubation techniques/tube materials for nasotracheal intubation. Can J Anesth/J Can Anesth (2024). https://doi.org/10.1007/s12630-024-02743-z

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