title: Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis.
abstract: BACKGROUND
  Nasotracheal intubation (NTI) has greater potential for trauma of nasopharyngeal mucosa than orotracheal intubation. The present study investigated the success rate of NTI and frequency of nasal bleeding using a curve-tipped suction catheter (CTSC) to guide nasotracheal tube advancement.
  
  
  METHODS
  Subjects comprised 131 adult patients who under-went NTI. Subjects were randomly divided into two groups: a) NTI under CTSC guidance (G[+] group). The CTSC (14 Fr) was first inserted through the tracheal tube, with the tip of the CTSC emerging from the distal end of the tube. The curved tip was directed ventrally. Both tracheal tube and CTSC were advanced together through the nasopharynx; b) NTI without CTSC guidance (G[-] group). The tracheal tube was advanced into the nasal cavity and passed into the pharynx without CTSC guidance. The time required to pass the endotracheal tube through the nasal cavity (nasal passage time), success rate of nasal passage with nasotracheal tube, and the incidence and severity of nasal bleeding were compared.
  
  
  RESULTS
  Success rate for nasal passage was 100% in the G(+) group (62/62) and 82.6% in the G(-) group (57/69; P = 0.0006). Frequency of nasal bleeding was significantly lower in the G(+) group (21/62, 33.9%) than in the G(-) group (37/69, 53.6%; P = 0.023). Severity of nasal bleeding was also significantly lower in the G(+) group than in the G(-) group (P = 0.030).
  
  
  CONCLUSIONS
  Nasotracheal intubation under CTSC guidance increases the success rate of airway instrumentation, and also reduces the incidence and severity of epistaxis.
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan. ysn-mori@dent.osaka-u.ac.jp
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugimura
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Hirose
authors.forename: Kunitaka
authors.initials: K
authors.lastname: Taki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000328:Adult; D002404:Catheterization / Q000295:instrumentation; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008297:Male; D013396:Suction; D016896:Treatment Outcome