Does Suction Catheter-Guided Nasotracheal Intubation Reduce Nasal Bleeding?

Abstract

Background: Nasal bleeding is common during nasotracheal intubation (NTI) and can complicate the procedure. It is unclear if suction catheter use reduces complications, including bleeding.

Purpose: The purpose was to measure and compare adverse outcomes of suction catheter-guided nasal passage to conventional NTI technique.

Study design, setting, and sample: A double-blind, randomized controlled trial was conducted at Mahidol University Dental Hospital, Thailand. Patients (18-65 years, American Society of Anesthesiologists physical status 1-2 and normal body mass index) scheduled for elective surgery requiring NTI were recruited, excluding those with anticipated difficult intubation or nasal abnormalities.

Predictor variable: The predictor variable was intubation technique (suction catheter-guided or conventional intubation).

Main outcome variables: Primary outcomes were incidence and extent of bleeding (nasal bleeding observed at posterior pharynx), graded during intubation. Secondary outcomes were ease of intubation, first-pass success, number of attempts, and nasal passage time.

Covariates: Covariates included demographic (age, sex), perioperative (body mass index, tobacco, alcohol, mild allergic rhinitis), and operative data (nostril side).

Analyses: Categorical data were compared using Pearson's χ² or Fisher's exact test. Continuous data were compared using independent t-test or Mann-Whitney U test. P value < .05 was considered statistically significant.

Results: The sample included 52 subjects (26 per group), mean age 29.8 ± 10.0 years (P = .4); 31 (59.6%) were female (P = .8). No significant differences were found between guided and control groups in incidence of bleeding (13 [50%] vs 14 [53.8%], P = .8), extent of bleeding (grade 0-3, respectively: 13 [50.0%], 3 [11.5%], 3 [11.5%], 7 [26.9%] vs 12 [46.2%], 3 [11.5%], 4 [15.4%], 7 [26.9%], P = 1.0), ease of navigation (P = .6), first-pass success (25 [96.2%] vs 22 [84.6%], P = .4), or number of attempts (P = .5). Nasal passage time was longer in the guided group (10.3 [interquartile range: 8.9-12.2] vs 5.4 [4.2-7.7] seconds, P < .001), though not clinically significant.

Conclusions and relevance: Suction catheter-guided nasal passage during NTI under general anesthesia does not statistically reduce nasal bleeding or improve navigability in patients without nasal bleeding risk factors or anticipated difficulties. Nasal passage time is longer in the guided group, but without adverse events.