Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation
Background. Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method. A diagnostic prosp...
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Wiley
2018-01-01
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| Series: | Anesthesiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/4910653 |
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| author | Cattleya Thongrong Pattramon Thaisiam Pornthep Kasemsiri |
| author_facet | Cattleya Thongrong Pattramon Thaisiam Pornthep Kasemsiri |
| author_sort | Cattleya Thongrong |
| collection | DOAJ |
| description | Background. Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method. A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient’s own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results. The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations. The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation. |
| format | Article |
| id | doaj-art-e90e1828b123484aa26dfdddc7fd3b4b |
| institution | DOAJ |
| issn | 1687-6962 1687-6970 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Anesthesiology Research and Practice |
| spelling | doaj-art-e90e1828b123484aa26dfdddc7fd3b4b2025-08-20T03:21:09ZengWileyAnesthesiology Research and Practice1687-69621687-69702018-01-01201810.1155/2018/49106534910653Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal IntubationCattleya Thongrong0Pattramon Thaisiam1Pornthep Kasemsiri2Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandDepartment of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandDivision of Skull Base Surgery, Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandBackground. Nasotracheal intubation is a blind procedure that may lead to complications; therefore, several tests were introduced to assess a suitable nostril for nasotracheal intubation. However, the value of simple tests in clinical practice was insufficient to evaluate. Method. A diagnostic prospective study was conducted in 42 patients, ASA classes I–III, undergoing surgery requiring nasotracheal intubation for general anesthesia. Two simple methods for assessing the patency of nostrils were investigated. Firstly, the occlusion test was evaluated by asking for the patient’s own assessment of nasal airflow during occlusion of each contralateral nostril while in a sitting posture. Secondly, patients breathed onto a spatula held 1 cm below the nostrils while in a sitting posture. All patients were assessed using these two simple tests. Nasal endoscopic examination of each patient was used as a gold standard. Results. The diagnostic value of the occlusion test (sensitivity of 91.7%, specificity of 61.1%, PPV of 75.9%, NPV of 84.6%, LR+ of 2.36, and LR− of 0.14) seemed better than that of the spatula test (sensitivity of 95.8%, specificity of 25.0%, PPV of 63.0%, NPV of 81.8%, LR+ of 1.28, and LR− of 0.17). When both tests were combined in series, the diagnostic value increased (sensitivity of 87.9%, specificity of 70.8%, PPV of 80.1%, NPV of 81.4%, LR+ of 3.01, and LR− of 0.17). Conclusion and Recommendations. The simple occlusion test is more useful than the spatula test. However, combining the results from both tests in series helped to improve the diagnostic value for selecting a suitable nostril for nasotracheal intubation.http://dx.doi.org/10.1155/2018/4910653 |
| spellingShingle | Cattleya Thongrong Pattramon Thaisiam Pornthep Kasemsiri Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation Anesthesiology Research and Practice |
| title | Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation |
| title_full | Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation |
| title_fullStr | Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation |
| title_full_unstemmed | Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation |
| title_short | Validation of Simple Methods to Select a Suitable Nostril for Nasotracheal Intubation |
| title_sort | validation of simple methods to select a suitable nostril for nasotracheal intubation |
| url | http://dx.doi.org/10.1155/2018/4910653 |
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