Nasotracheal Intubation Over a Bougie

Study Overview
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Brief Summary
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The purpose of this study is to determine whether nasal intubation over a bougie placed via a nasal trumpet will decrease nasal trauma when compared to the conventional technique of blind nasal endotracheal tube passage.

Detailed Description
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Conventional nasotracheal intubation techniques (or Conventional Videolaryngoscopic Techniques, CVT) are known to be associated with significant trauma to the patient's nares and the endotracheal tube itself. The investigators propose an alternative technique (Nasotracheal intubation over a bougie placed via a subsequently removed nasal trumpet, or NIB) which involves using Seldinger technique over a bougie placed via a nasal trumpet which promises to not only be less traumatic to the patient and the endotracheal tube, but also to take less time to perform and have a higher first-attempt success rate than conventional methods. The investigators propose a randomized prospective interventional study comparing this new technique with conventional technique to see if a significant difference exists.

Official Title
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Nasotracheal Intubation Over a Bougie Placed Via a Subsequently Removed Nasal Trumpet

Conditions
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Nasotracheal Intubation, Nasal Bleeding

Intervention / Treatment
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* Procedure: Nasotracheal intubation over a bougie
* Procedure: Conventional Nasotracheal Intubation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for elective surgery with an anesthetic plan including asleep nasotracheal intubation Exclusion Criteria: Patients needing emergent airway protection Patients undergoing emergency surgery Patients whom are known to be pregnant Patients whom are currently anticoagulated (including daily aspirin use) Patients whose anesthetic includes the use of nitrous oxide Patients whom are currently incarcerated Patients 7 years of age or younger Mentally incompetent adults Patients whom refuse involvement in the study

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional Nasotracheal Intubation (CVT)<br>Blind passage of an endotracheal tube via the nare followed by videolaryngoscopy-assisted passage through the glottis, with or without the aid of Magill forceps | Procedure: Conventional Nasotracheal Intubation<br>* Blind passage of an endotracheal tube via the nare followed by videolaryngoscopy-assisted passage through the glottis, with or without the aid of Magill forceps<br>* Other names: CVT;|
| Experimental: Nasotracheal Intubation Over a Bougie (NIB)<br>Nasotracheal intubation over a bougie, placed with videolaryngoscopy assistance, via a nasopharyngeal airway with or without the aid of Magill forceps | Procedure: Nasotracheal intubation over a bougie<br>* Nasotracheal intubation over a bougie, placed with videolaryngoscopy assistance, via a nasopharyngeal airway with or without the aid of Magill forceps<br>* Other names: NIB;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nasal trauma | Bleeding noted on nasopharyngeal exam by surgical resident | 60-90 seconds post-intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nasal trauma | Bleeding noted on nasopharyngeal exam by surgical resident | 5 minutes post-intubation | 
| Time to intubation | Time from first entrance of ETT or bougie into the nare to the presence of end-tidal CO2 via nasotracheal ETT | Measured immediately post-intubation | 
| First attempt success rate | Whether or not there was successful nasotracheal intubation on the first attempt | Measured immediately post-intubation | 
| Need for Magill forceps | Whether or not Magill forceps were used during airway management | Measured Immediately post-intubation | 

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