Guidewire Use in Nasotracheal Intubation

Not Applicable

Completed

• Conditions: Epistaxis Nosebleed; Pharyngeal Bleeding
• Interventions: Device: Nasotracheal intubation with conventionally; Device: Nasotracheal intubation with angled ETT using guidewire

• Registration Number: NCT05937516
• Lead Sponsor: Bezmialem Vakif University

Brief Summary

During nasotracheal intubation, nasopharyngeal trauma and associated bleeding may occur. The investigators think that some of this bleeding is due to trauma to the posterior wall of the nasopharynx. The investigators designed this study, thinking that if nasopharyngeal posterior wall trauma can be prevented, some of these bleedings can be prevented.

Detailed Description

Nasotracheal intubation (NTI) is a frequently used airway management method in pedodontic dental treatments performed under general anesthesia. However, nasopharyngeal trauma and associated bleeding are common during conventional NTI. In this study, the investigators aimed to examine the effect of angling the end of the endotracheal tube (ETT) by placing a guide wire inside the ETT on nasopharyngeal bleeding.

The patients included in the study were randomized into two groups. In the control group (Group C), NTI will be done conventionally. In the study group (Group S), a guide wire will be inserted into the ETT before intubation and angled 100-120 degrees to the distal end (in the shape of a hockey stick). The angulation will not be sharp but slightly curved and the apex of the angulation will be 2.5-3 cm proximal from the distal end. The ETT will be positioned perpendicular to the face and inserted into the nostril. After the angled part of the ETT passes through the nostrils, it will be directed to caudally according to the angle given to the tip of the ETT. Meanwhile, the ETT will be moved as a whole to prevent the ETT tip from contacting the posterior wall of the nasopharynx. When the ETT tip reaches the oropharynx, the guidewire will be removed and the rest of the intubation will be completed as in the conventional method.

Study Timeline

• Study Start: 2023-03-15
• Primary Completion: 2023-04-20
• Study Completion: 2023-04-20
• Study First Submitted: 2023-06-20
• Status Verified: 2023-07
• Study First Submitted QC: 2023-07-06
• Last Update Submitted: 2023-07-06
• Study First Posted: 2023-07-10
• Last Update Posted: 2023-07-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

• 2-12 years old
• American Society of Anesthesiologists I-III
• Patients with elective dental surgery
• Patients whose parents have accepted informed consent forms
• Patients without previous nasopharyngeal anomalies
• Patients without previous nasopharyngeal surgeries
• Patients without upper airway infections

Exclusion Criteria

• Under 2 or over 12 years old
• Emergency surgeries
• Patients whose parents have not accepted informed consent forms
• Patients with previous nasopharyngeal anomalies
• Patients with previous nasopharyngeal surgeries
• Patients with upper airway infections

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control Group	Nasotracheal intubation with conventionally	Nasotracheal intubation will be applied conventionally to patients in this group.
Study Group	Nasotracheal intubation with angled ETT using guidewire	In the study group (Group S), a guide wire will be inserted into the ETT before intubation and angled 100-120 degrees to the distal end (in the shape of a hockey stick). The angulation will not be sharp but slightly curved and the apex of the angulation will be 2.5-3 cm proximal from the distal end. The ETT will be positioned perpendicular to the face and inserted into the nostril. After the angled part of the ETT passes through the nostrils, it will be directed to caudally according to the angle given to the tip of the ETT. Meanwhile, the ETT will be moved as a whole to prevent the ETT tip from contacting the posterior wall of the nasopharynx. When the ETT tip reaches the oropharynx, the guidewire will be removed and the rest of the intubation will be completed as in the conventional method.

Primary Outcome Measures

Name	Time	Method
Presence of blood in oropharynx or on the endotracheal tube	In the fifth minute after intubation	The presence of blood in the oropharynx or endotracheal tube will be defined by assessing it on a scale. (0 = no blood, 2 = mild, that is, dye-like blood on the endotracheal tube, 3 = severe, that is, obvious blood in the oropharynx).

Trial Locations

Locations (1)

Bezmialem Vakif University, Faculty of Medicine; 🇹🇷 Fatih, Istanbul, Turkey