Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial
Background The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotrach...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Anesthesiologists
2024-12-01
|
| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-24337.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850138273088798720 |
|---|---|
| author | Jun-Young Park Jihion Yu Chan-Sik Kim Taeho Mun Woo Shik Jeong Jong Woo Choi Kichang Lee Young-Kug Kim |
| author_facet | Jun-Young Park Jihion Yu Chan-Sik Kim Taeho Mun Woo Shik Jeong Jong Woo Choi Kichang Lee Young-Kug Kim |
| author_sort | Jun-Young Park |
| collection | DOAJ |
| description | Background The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril. Methods Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy. Results The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group. Conclusions The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation. |
| format | Article |
| id | doaj-art-bc7680a2328640afb92cd5f2dcef1aec |
| institution | OA Journals |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-bc7680a2328640afb92cd5f2dcef1aec2025-08-20T02:30:37ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632024-12-0177659660410.4097/kja.243379005Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trialJun-Young Park0Jihion Yu1Chan-Sik Kim2Taeho Mun3Woo Shik Jeong4Jong Woo Choi5Kichang Lee6Young-Kug Kim7 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaBackground The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril. Methods Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy. Results The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group. Conclusions The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.http://ekja.org/upload/pdf/kja-24337.pdfairway managementcomplicationsepistaxisintubationnosepatient satisfaction |
| spellingShingle | Jun-Young Park Jihion Yu Chan-Sik Kim Taeho Mun Woo Shik Jeong Jong Woo Choi Kichang Lee Young-Kug Kim Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial Korean Journal of Anesthesiology airway management complications epistaxis intubation nose patient satisfaction |
| title | Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
| title_full | Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
| title_fullStr | Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
| title_full_unstemmed | Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
| title_short | Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial |
| title_sort | reverse tube direction and epistaxis in left nasotracheal intubation a randomized controlled trial |
| topic | airway management complications epistaxis intubation nose patient satisfaction |
| url | http://ekja.org/upload/pdf/kja-24337.pdf |
| work_keys_str_mv | AT junyoungpark reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT jihionyu reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT chansikkim reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT taehomun reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT wooshikjeong reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT jongwoochoi reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT kichanglee reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial AT youngkugkim reversetubedirectionandepistaxisinleftnasotrachealintubationarandomizedcontrolledtrial |