| Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
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Jun-Young Park1, Jihion Yu1, Chan-Sik Kim1, Taeho Mun1, Woo Shik Jeong2, Jong Woo Choi2, Kichang Lee3,4, Young-Kug Kim1 |
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
3Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
4Harvard Medical School, Boston, MA, USA |
Corresponding author:
Young-Kug Kim, Tel: +82-2-3010-5976, Fax: +82-2-3010-6958,
Email: kyk@amc.seoul.kr
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Received: 20 May 2024 • Revised: 5 August 2024 • Accepted: 12 August 2024 |
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| Abstract |
Background
The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril.
Methods
Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy.
Results
The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk = 0.45; 95% CI: 0.24, 0.85; absolute risk reduction = 29.8%; number needed to treat = 3.36). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group.
Conclusions
The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation. |
| Key Words:
Airway management; Complication; Epistaxis; Nasotracheal intubation; Tube bevel; Tube tip |
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