The Effect of 'Sniffing Position & Nasal Tip Lifting' in Nasotracheal Intubation

Study Overview
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Brief Summary
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The goal of this prospective randomized study is to compare the effect of nasal tip lifting during nasotracheal intubation. The question the investigators are trying to answer is: If the nasal tip is tilted, will the E-tube be more likely to enter the lower passage during nasal intubation?

Detailed Description
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There are three nasal turbinates inside the nasal cavities. Each nasal cavity is divided into four spaces from these nasal turbinates, but the two spaces separated by the upper nasal turbinate are too narrow to be clinically meaningful. So when performing nasotracheal intubation, the tube enters one of the two spaces in low part divided into the lower turbinate. The middle turbinate, unlike others, a large number of blood vessels and nerves are distributed. Therefore, less hemorrhage might occurs when the tracheal tube enters into the lower pathway below the lower turbinate because the tube would not scratching the middle turbinate. The hypothesis of this study is that the method 'sniffing position and nasal tip lifting' increases possibility to enter into lower pathway when the tube enters the nasal cavity. The purpose of a present study was to investigate the effect of 'sniffing position & nose' on the intranasal route of the tube.

Official Title
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The Effect of 'Sniffing Position & Nasal Tip Lifting' on the Pathway of Tracheal Tube in Nasal Cavity During Nasotracheal Intubation

Conditions
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Intubation Complication

Intervention / Treatment
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* Procedure: Sniffing position
* Procedure: Nasal tip lifting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patients who need to nasotracheal intubation for surgery. Exclusion Criteria: Who doesn't agree to enroll. Who has severe nasal deformities. Who has a problem to make sniffing position or nasal tip lifting Who has severe nasal bleeding history.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional<br>Performed nasotracheal intubation as usual. Sniffing position but doesn't lift a nasal tip. | Procedure: Sniffing position<br>* All procedure is done under sniffing position.<br>|
| Experimental: Nasal tip lifting<br>Performed sniffing position and nasal tip lifting while the endotracheal tube insert patient's nasal cavity. | Procedure: Sniffing position<br>* All procedure is done under sniffing position.<br>Procedure: Nasal tip lifting<br>* Before inserting the endotracheal tube to patient's nose, the researcher lift up the nose tip.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with nasal endotraheal tube in the lowest nasal pathway. | After the endotracheal intubation is completed, the experimenter confirms by a fiberoptic bronchoscope which path the endotracheal tube is located. | Through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nasal bleeding | After nasotracheal intubation, the researcher confirm there is nasal bleeding or not. And if bleeding observed, the experimenter would check the amount. | Through study completion, an average of 1 year | 
| Intubation time | Check the time from initiation of insertion of E-tube to finish passing nasal path and to finish intubation. | Through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nasotracheal intubation