title: Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial.
abstract: OBJECTIVE
  To determine which nostril is more suitable for nasotracheal intubation in patients with normal patency of both nostrils.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Operating room of a university medical center.
  
  
  METHODS
  191 ASA physical status 1 and 2 patients scheduled for elective oral surgery requiring general anesthesia with nasotracheal intubation.
  
  
  METHODS
  Patients were randomized to two groups to undergo nasotracheal intubation through the right nostril (Group R; n = 96) or the left nostril (n = 95). Standard traditional nasotracheal intubation was performed using the Macintosh laryngoscope. Tube rotation was attempted for alignment toward the glottis, and Magill forceps were then used to assist intubation, as necessary.
  
  
  METHODS
  Epistaxis was inspected in the pharynx after the tube tip was passed through the nasal cavity and 15 minutes after nasotracheal intubation was completed. Intubation time was the interval between when the anesthesiologist opened the patient's mouth with the cross finger maneuver and when the tube was connected to the anesthetic circuit after nasotracheal completion.
  
  
  RESULTS
  The frequency of epistaxis was significantly lower in Group R than Group L (P = 0.0006). Although there was no significant difference in nasal passage time between two groups, the intubation time in Group R (24.5 ± 9.4 sec) was shorter than in Group L (30.5 ± 15.6 sec; P = 0.0015).
  
  
  CONCLUSIONS
  Nasal intubation via the right nostril is more safely performed than with the left nostril. Because of less epistaxis and faster intubation.
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan. Electronic address: bokuaiji@dent.osaka-u.ac.jp.
authors.forename: Aiji
authors.initials: A
authors.lastname: Boku
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hanamoto
authors.affiliation: Sakai Special Needs Dental Clinic, 18-3 Daisen Nakamachi, Sakai 590-0801, Japan.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Hirose
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Kudo
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Morimoto
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Mistutaka
authors.initials: M
authors.lastname: Sugimura
authors.affiliation: Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Niwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D017558:Elective Surgical Procedures / Q000379:methods; D004844:Epistaxis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D009296:Nasal Cavity / Q000502:physiology*; D019647:Oral Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Epistaxis; Intubation time; Nasal cavity; Nasal passage time; Nasotracheal intubation; Nasotracheal tube rotation