EFFECT OF BEVEL DIRECTION OF THE ENDOTRACHEAL TUBE ON THE PROPORTION OF CASES DEVELOPING EPISTAXIS DURING NASOTRACHEAL INTUBATION-A RANDOMIZED CONTROLLED INTERVENTIONAL STUDY

Objective: Nasotracheal intubation is associated with a number of complications, most commonly nasal trauma or epistaxis. The aim of the study is to determine the effect of conventional versus cephalad direction of the bevel of endotracheal tube on the development of epistaxis during nasotracheal intubation. Methods: A total of 74 adults aged 18 to 50 y posted for surgeries requiring nasotracheal intubation were randomly divided into group A (Conventional) and group B (Interventional). After induction of anesthesia, in group a bevel direction of thermo softened PVC endotracheal tube was towards the nasal septum in the nasal passage and cephalad in group B, later nasotracheal intubation was completed with direct laryngoscopy and Magill forceps. After five minutes direct laryngoscopy was done to check for presence of epistaxis and its severity. Degree of resistance, nasal passage time, intubation time and haemodynamic parameters (heart rate, blood pressures) were also assessed and compared. Results: The incidence of epistaxis was significantly lower in group B (Interventional) than group A (Conventional) [15 vs 27; p-value = 0.005], severity of epistaxis [0/1/2] were also significantly lower in group B [22/12/3] than group A [10/15/12] [p value = 0.001]. There was significant difference in haemodynamic parameters between both groups at 1 min till 7 min post intubation. There was no significant difference in degree of resistance, nasal passage time and mean intubation time. Conclusion: The cephalad direction of the bevel of endotracheal tube in nasal passage during nasotracheal intubation decreases the chances of developing epistaxis and its severity. Hemodynamic parameters are also more stable in cephalad direction.