A comparative study of two methods of nasal tracheal fiberoptic intubation

Abstract

Introduction: Conventional fiberoptic intubation in a well anesthetized and prepared airway is found difficult with success rates of around 68%. The difficulty presents in the form of longer duration taken for intubation, coughing and bleeding. This study aimed to compare two facilitated methods designed to reduce time taken, complication rate, ease of insertion and hemodynamic stability.
Methodology: After institute ethical committee clearance and a written informed consent, patients were randomly divided into two groups. Both groups were prepared, as per current standards. In Group-A (endotracheal tube group), the endotracheal tube was first inserted till 18 cm mark at the alae of nose. Fiberscope was passed through the tube, and navigated to pass through the true vocal cords and its adequate placement was confirmed. In the other group – Group-B (nasopharyngeal airway group), a spirally split Rusch® nasopharyngeal airway of adequate size was warmed, lubricated and inserted in the nasal cavity. Fiberscope was passed through the airway, vocal cords were visualized, and the nasopharyngeal airway was removed before railroading the pre-loaded tube through the vocal cords and correct placement was confirmed. Time taken to intubate, cough episodes, bleeding and hemodynamic parameters were recorded.
Results: The time taken for intubation in Group-A was 79.76 sec as compared to 44.15 sec in Group-B (p < 0.001). The increase in heart rate and mean arterial blood pressure were found to be significantly higher Group-A than those in Group-B.