Comparison of Cuff Inflation and Conventional Technique for Nasotracheal Intubation using C-MAC Video Laryngoscope. A Prospective Randomised Controlled Trial.

Surgical procedure involving head and neck region, intraoral, maxillofacial and dental procedures usually mandate nasotracheal intubation (NTI). Advantage of NTI is that it better isolates surgical field from artificial airway so that the endotracheal tube is less vulnerable to kinking, damage due to surgical instrumentations. In addition, postoperatively nasal tube is better tolerated than the oral route and require less sedation. Nasotracheal intubation involve passing of tube through one of the nostril till the tube reaches nasopharynx and then with help of video or macintosh laryngoscope it is guided through vocal cord by various manoeuvres like burp, neck movement, tube rotation, use of bougie or by using Magill’s forceps. These manoeuvres lead to longer intubation time, trauma, bleeding of nasopharyngeal wall and hemodynamic stress response while negotiating the tube into trachea. 

Cuff inflation technique (wherein the cuff of ET tube is inflated with air) in which after inflation of the cuff  the endotracheal tube is lifted away from the posterior pharyngeal wall and gets aligned with the laryngeal inlet  and  tip of the tracheal tube is engaged with  the glottis opening. Once the tip of tube passes through the glottis, cuff is deflated and tube is further advanced.

Cuff inflation technique has not been compared with conventional technique yet. Hence, we plan to compare these two techniques of nasal intubation. We hypothesize that cuff inflation technique will have faster intubation time and less manipulation in comparison to conventional nasal intubation technique.