Comparison Among Three Different Video Scope Guided Nasotracheal Intubation.

Study Overview
=================
Brief Summary
-----------------
Nasotracheal intubation (NTI) has become the most optimal alternative to oral endotracheal intubation for oro-maxillofacial surgery because it can offer an excellent vision field of the mouth. Additional benefits include milder oropharynx stimulation, less airway secretions, and better tolerance for long term endotracheal intubation maintenance. Traditional NTI is performed under the guidance of indirect laryngoscope, which is often accompanied by longer maneuver time and adverse complications such as trauma and bleeding. The development of various visualization tools such as video laryngoscope, video fiberoptic scope and video rigid laryngoscope has greatly improved NTI. However, there is no consensus on which one is the best adjunctive device for NTI. Therefore, a study on a comparison of the clinical efficacy of the above three video scope guided methods for NTI will be conducted.

Detailed Description
-----------------
A total of 60 eligible patients will be enrolled in this prospective study, they are scheduled to undergo elective oro-maxillofacial surgeries under general anaesthesia with nasotracheal intubation in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. According to the kinds of video methods uesd to assist in nasotracheal intubation, patients will be randomly divided into video laryngoscope group, video fiberoptic scope group and video rigid laryngoscope group, 20 participants in each group. The data of the duration of catheter reaching oropharynx (T1), the duration of catheter reaching glottis (T2), successful intubation time (T3), the first-attempt intubation success rate, the total number of intubations for each participant, whether there is oral and nasal mucosa bleeding, whether the tracheal ring is pressed, whether the catheter is rotated, the heraodynamic changes, and the occurrence of throat complications within 2 hours after surgery, will be recorded respectively.

Official Title
-----------------
Comparison Among Three Different Video Scope Guided Nasotracheal Intubation: a Prospective, Non-randomised Controlled Trial

Conditions
-----------------
Intubation, Intratracheal, Airway Management

Intervention / Treatment
-----------------
* Behavioral: video laryngoscope guided nasotracheal intubation
* Behavioral: video rigid laryngoscope guided nasotracheal intubation
* Behavioral: video fiberoptic scope guided nasotracheal intubation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants scheduled for elective oro-maxillofacial surgery under general anesthesia. Age between 18 and 65 years old. The American Society of Anesthesiologists (ASA) Ⅰ～Ⅱ. Body mass index (BMI) 18.5～24.9kg/m2. Mallampati Ⅰ～Ⅱ. Able to give informed consent. Exclusion Criteria: Participants with severe intranasal diseases. Participants with severe and uncontrolled clotting diseases. Participants with skull base fractures and cerebrospinal fluid leakage. Participants with unstable cardiovascular and cerebrovascular diseases, or with poor tolerance to vagal stimulation. Participants who are deemed ineligible for participation in the clinical trial by the investigator. Participants who have to receive the alternative therapy to establish ventilation after the several attempts for nasotracheal intubation.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: According to the kinds of video methods uesd to assist in nasotracheal intubation, patients will be randomly divided into video laryngoscope group, video fiberoptic scope group and video rigid laryngoscope group, 20 participants in each group.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: video rigid laryngoscope group<br>Similarly during intubation, the patient should be placed in the supine position with the neutral head. The endoscopic body of video rigid laryngoscope covered by a lubricated endotracheal tube enters the airway through the nasal cavity, then proceeds under visual conditions. When the epiglottis is exposed, if necessary, gently lift the patient's lower jaw so that the glottis is fully visible. The tube is pushed to approach and pass the glottis. Withdraw the endoscopic body while adjusting the depth of tube in the trachea. The intubation ends with tube fixation. | Behavioral: video rigid laryngoscope guided nasotracheal intubation<br>* According to the kinds of video methods uesd to assist in nasotracheal intubation, participants will be divided into video rigid laryngoscope group. The data of the duration of catheter reaching oropharynx (T1), the duration of catheter reaching glottis (T2), successful intubation time (T3), the first-attempt intubation success rate, the total number of intubations for each participant, whether there is oral and nasal mucosa bleeding, whether the tracheal ring is pressed, whether the catheter is rotated, the heraodynamic changes, and the occurrence of throat complications within 2 hours after surgery, will be recorded respectively.<br>|
| Experimental: video laryngoscope group<br>First of all, participants will be asked to take supine position with neutral head. The operator will insert a lubricated endotracheal tube through the nasal cavity into the oropharynx, while he/she holds the handle of video laryngoscope in his/her left hand. Laryngoscope blade can be placed into oral cavity along the right corner of the patient's mouth, and the tongue is pushed to the left by moving the handle. Blade should arrive at a suitable depth to fully expose the epiglottis and glottis. After that, the operator can push the catheter with the right hand to approach and pass the glottis, sometimes Magill forceps are necessary. Finally, the tube is inserted into the trachea to the appropriate depth and fixed firmly. | Behavioral: video laryngoscope guided nasotracheal intubation<br>* According to the kinds of video methods uesd to assist in nasotracheal intubation, participants will be divided into video laryngoscope group. The data of the duration of catheter reaching oropharynx (T1), the duration of catheter reaching glottis (T2), successful intubation time (T3), the first-attempt intubation success rate, the total number of intubations for each participant, whether there is oral and nasal mucosa bleeding, whether the tracheal ring is pressed, whether the catheter is rotated, the heraodynamic changes, and the occurrence of throat complications within 2 hours after surgery, will be recorded respectively.<br>|
| Experimental: video fiberoptic scope group<br>It is suggested to apply paraffin oil to the surface of the insertion tube of video fiberoptic scope, where the friction with the inner wall of the endotracheal catheter will be reduced. The insertion tube together with a lubricated endotracheal tube will be placed into the nasopharynx through the nasal cavity of patient who takes supine position with neutral head. Push the insertion tube slowly and continuously along the airway until cuff passes through the glottis. Next carefully, the endotracheal tube can be delivered into the trachea, and the insertion tube can be withdrawn from the trachea. At last, the tracheal catheter can be fixed after the depth is adjusted to an appropriate level. | Behavioral: video fiberoptic scope guided nasotracheal intubation<br>* According to the kinds of video methods uesd to assist in nasotracheal intubation, participants will be randomly divided into video fiberoptic scope group. The data of the duration of catheter reaching oropharynx (T1), the duration of catheter reaching glottis (T2), successful intubation time (T3), the first-attempt intubation success rate, the total number of intubations for each participant, whether there is oral and nasal mucosa bleeding, whether the tracheal ring is pressed, whether the catheter is rotated, the heraodynamic changes, and the occurrence of throat complications within 2 hours after surgery, will be recorded respectively.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the duration of catheter reaching oropharynx | time requirements for delivering the anterior segment of the endotracheal tube from the nasal cavity to the oropharynx | within 1 minute | 
| the duration of catheter reaching glottis | time requirements for the anterior segment of the endotracheal tube from being put into the nasal cavity to the glottis being exposed | within 1 minute | 
| successful intubation time | time requirements for delivering the anterior segment of the endotracheal tube from the nasal cavity to the trachea | within 3 minute | 
| the first-attempt intubation success rate | number of successful first-attempt intubation/total number of intubations | anticipated eight months | 
| average number of intubations | average number of nasotracheal intubations for each participant | anticipated eight months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the number of participants whose oral and nasal mucosa bleeds during intubation | during nasotracheal intubation, whether airway soft tissue is damaged, such as bleeding | within 3 minute | 
| the number of participants whose tracheal ring is pressed and catheter is rotated when intubation | during nasotracheal intubation, record whether the operator presses the tracheal ring and rotates the tracheal tube to assist intubation | within 3 minute | 
| Blood pressure values before and after intubation intubation | record blood pressure values before and after intubation | 20 minute | 
| Heart rate values before and after intubation intubation | record heart rate before and after intubation | 20 minute | 
| the occurrence of throat complications | inquiry and record intubation related complications, such as sore throat and hoarseness | within 2 hours after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
nasotracheal intubation