Suction Catheter as a Guide for Nasotracheal Intubation Under General Anesthesia

Not Applicable

Completed

Brief Summary: The goal of this clinical trial to study the efficacy of suction catheter guided technique and conventional technique during nasotracheal intubation.

The main question are

* How effective of the use of a suction catheter guided ETT in reducing bleeding during nasotracheal intubation?

* Does the use of a suction catheter guided ETT can improve its navigability through the nasal passage and reduce nasal passage time?

Detailed Description: Study design Clinical trial: Prospective randomized controlled trial with equal randomization (1:1), double-blinded (Participant and Primary outcome assessor), parallel design

Recruitment & Eligibility

Inclusion Criteria

Patient undergoing elective oral and maxillofacial surgery in which nasotracheal intubation is preferred over orotracheal intubation to optimize surgical access.
ASA physical status I-II
Thai adult, aged 18-65 years old
Normal Body Mass Index (BMI = 18.5-24.9)

Exclusion Criteria

Anticipated difficult airway (e.g., Mallampati classification 3-4, interincisal distance < 35 mm., thyromental length < 60 mm., limited neck mobility)
Nasal infection or systemic infection
Abnormal coagulation status or having bleeding disorder or taking anticoagulation/antiplatelet medication
History of recurrent epistaxis since adulthood
Allergic rhinitis that necessitates the use of glucocorticoids, antihistamine, antileukotriene or decongestant in the past 4 weeks
History of nasal trauma or abnormality (e.g., trauma in mid-face region, nasal surgery, nasal polyps, chronic sinusitis, abnormal nasal vasculature, tumor in nasal region, radiotherapy in nasal region)
Craniofacial deformity syndrome
Using nasal oxygen or Continuous Positive Airway Pressure (CPAP)
Previous nasotracheal intubation or nasogastric tube placement within 3 months
Diagnosed as having a mental disorder

Drop-out criteria:

Unable to complete intubation procedure
Intubation failed on both nostrils
When intubation was only possible with a tube smaller than 6.5 internal diameter (ID) in male and 6.0 ID in female
Inadequate data collection

Arm && Interventions

Group	Intervention	Description
Guided group	suction catheter	use suction catheter guided endotracheal tube through the nasal passage

Primary Outcome Measures

Name	Time	Method
Extent of Bleeding	measured from video recorded at insert to withdraw videolaryngoscope	The video from video laryngoscope will be recorded at the moment during and immediately after successful intubation, which will be later reviewed by primary outcome assessor that not involved in the procedure. Accounting for only bleeding observed at posterior pharyngeal area, which originate from trauma from attempt to pass ETT through the nasal passage into the pharynx. Assessment of bleeding will be scored at the most severe bleeding state observed from inserting to the removal of video laryngoscope after successful intubation. The extent of bleeding will be graded as: "Grade 0" = no bleeding "Grade 1" = blood-stained tube and/or cuff "Grade 2" = blood-stained posterior pharyngeal wall (traces or streak of blood) "Grade 3" = blood pooling at posterior pharyngeal wall
Incidence of Bleeding	measured immediately after successful intubation	rate of incidence of bleeding * No Bleeding (Grade 0) * Bleeding (Grade 1, 2, 3)

Secondary Outcome Measures

Name	Time	Method
Ease of Navigation	measured immediately after successful intubation	Ease of navigation during advancement of tube though the nasal passage, will be recorded as "Smooth" = ETT meet no resistance, no need to adjust the tube "Slight resistance" = ETT meet the resistance and has to be manipulated more than once "Impinged" = ETT cannot pass through and need to move to another nostril