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Comparison of Nasal Intubations by Glidescope With and Without a Bougie Guide in Patients Who Underwent Maxillofacial Surgeries: Randomized Clinical Trial Publisher Pubmed



Pourfakhr P3 ; Ahangari A1 ; Etezadi F3 ; Moharari RS3 ; Ahmadi A2 ; Saeedi N3 ; Najafi A3
Authors
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Authors Affiliations
  1. 1. Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Anesthesia and Analgesia Published:2018


Abstract

BACKGROUND: Nasotracheal intubation is commonly performed to provide a secure airway for the maintenance of general anesthesia in maxillofacial surgeries. Routine nasotracheal intubation is performed under general anesthesia by direct laryngoscopy, frequently with the aid of Magill forceps. This method can be time-consuming and may cause bleeding in the field of view. A gum elastic bougie (GEB) is a cheap, slender, and flexible device that could expedite nasotracheal intubation. The aim of this study was to evaluate the use of a GEB during nasotracheal intubation to facilitate the procedure and reduce the rate of complications. METHODS: In this randomized clinical trial study, 110 patients with American Society of Anesthesiologists (ASA) physical status I–II from 15 to 65 years of age were randomized into 2 equal groups. In both groups, a GlideScope and armored tube were used. In the GEB group, GEB was used to facilitate nasal intubation while the nasal intubation was performed without the aid of GEB in the routine group. The difficult intubation (defined as >1 attempt for intubation) was the primary outcome, and the duration of the intubation, the presence of traces of bleeding, the need for a tube replacement, and the usage of Magill forceps were the secondary outcomes. RESULTS: The incidence of bleeding in the GEB group was 1.81% vs 43.63% in the routine group (P < .001). In 5.5% of the GEB group, Magill forceps were used to advance the tube versus 67.3% in the routine group (P < .001). The mean time for intubation in GEB group was 48.63 ± 8.53 vs 55.9 ± 10.76 seconds in the routine group (P < .001). CONCLUSIONS: The GEB is a useful aid to nasotracheal intubation, reducing bleeding, the requirement for Magill forceps and, to a small degree, intubation time. A case exists for its routine use for this purpose. (Anesth Analg 2018;126:1641–5. Copyright © 2018 International Anesthesia Research Society.