Comparison of Endotracheal Tube as a Conduit Versus the Conventional Technique for Flexible Intubating Video Endoscope Guided Nasotracheal Intubation, A Randomized Controlled Trial

Nasotracheal intubation using a flexible intubating video endoscope is commonly performed in patients undergoing head and neck and maxilofacial surgeries. However, the technique can be technically challenging and the time-consuming, particularly in patients with limited airspace and difficult anatomy. Various adjuncts have been described to facilitate endoscope guided nasotracheal intubation, including the use of an endotracheal tube as a conduit. This randomised controlled trial aims to compare the effectiveness and safety of using an endotracheal tube as a conduit versus the conventional technique for flexible intubating endoscope-guided nasotracheal intubation in adult patients. Participants will be randomly allocated to one of the two study groups. The primary outcome will be the time required to achieve successful nasotracheal intubation. Secondary outcome will be first attempt success rate ease of intubation, mucosal trauma and bleeding. Successful intubation will be confirmed by the presence of a consistent end tidal carbon dioxide waveform. Failed intubation will be managed according to standard institutional airway management protocols.The finding of the study are expected to provide evidence-based guidance on the optimal technique for flexible endoscope-guided nasotracheal intubation, potentially improving procedural efficiency and patient safety.