title: Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.
abstract: OBJECTIVE
  Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip™ (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel.
  
  
  METHODS
  Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed.
  
  
  RESULTS
  Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, -19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group.
  
  
  CONCLUSIONS
  There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.
authors.affiliation: Department of Anaesthesia, Vancouver Coastal Health, Suite JPP2449, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada. earle.rk@gmail.com.
authors.forename: Rosie
authors.initials: R
authors.lastname: Earle
authors.affiliation: Department of Anaesthesia, Vancouver Coastal Health, Suite JPP2449, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Enda
authors.initials: E
authors.lastname: Shanahan
authors.affiliation: Department of Anaesthesia, Vancouver Coastal Health, Suite JPP2449, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Himat
authors.initials: H
authors.lastname: Vaghadia
authors.affiliation: Department of Anaesthesia, Vancouver Coastal Health, Suite JPP2449, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sawka
authors.affiliation: Department of Anaesthesia, Vancouver Coastal Health, Suite JPP2449, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tang
mesh_terms: D000328:Adult; D004844:Epistaxis / Q000209:etiology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D008297:Male; D009296:Nasal Cavity; D016037:Single-Blind Method