| Background Magill forceps are frequently used to complete nasotracheal intubation（NTI）.We aimed to identify a tube core that could conveniently facilitate the NTI process without using Magill forceps.Methods Sixty patients with ASA grade I-II,aged 18-80 years old,BMI less than or equal to 30 kg/m~2,underwent oral and maxillofacial surgery in the Third Affiliated Hospital of Anhui Medical University（The First People’s Hospital of Hefei）were included.According to the different equipment selected for nasotracheal intubation,they were randomly divided into two groups（n=60,30 patients in each group）,namely the Magill forceps group（Group M）and the tube core group（Group T）.All manipulations were performed after induction of anesthesia.In both groups,an aseptic suction catheter was first inserted into the tracheal tube,and then the suction catheter was inserted along the nostrils.After the suction catheter reaches the nasopharynx,the endotracheal tube is advanced along the suction catheter.In Group M,a Macintosh laryngoscope was placed into the patient’s mouth,the glottis was exposed,and a reinforced endotracheal tube was advanced into the glottis using Magill forceps.In Group T,the suction catheter was withdrawn,and a reinforced endotracheal tube was inserted into a tube core pre-shaped and bent to the physiological curve of the nasal cavity and lubricated with sterile paraffin oil.A Macintosh laryngoscope was placed in the patient’s mouth,exposing the glottis.The endotracheal tube inserted into the tube core was directly operated by hand,and after it was advanced into the glottis,the tube core was pulled out.The total time of NTI in the two groups of patients was recorded,which was defined as the time from the anesthesiologist picking up the tracheal intubation-related equipment to the completion of the nasotracheal intubation and the connection to the ventilator.The total time until the end-tidal carbon dioxide waveform was obtained;the epistaxis of the two groups of patients was recorded.After five minutes of intubation,a Macintosh laryngoscope was used to open the oral cavity,and then the surface of the tracheal tube and the posterior pharyngeal wall were observed to evaluate the severity of epistaxis.It is divided into（1）no epistaxis:no blood observed on either the surface of the tube or the posterior pharyngeal wall;（2）mild epistaxis:blood apparent on the surface of the tube or posterior pharyngeal wall;（3）moderate epistaxis:pooling of blood on the posterior pharyngeal wall;（4）Severe epistaxis:a large amount of blood in the pharynx that impeded NTI and necessitated urgent orotracheal intubation;the nasal passages of the two groups of patients were recorded 15min,1h and 24h after the operation Visual analog scale（VAS）value of facial pain.Results All NTIs were completed successfully,and Magill forceps were not used on any patient in Group T.The total time of NTI in group T was less than that in group M and there was a significant difference in total NTI time between the two groups（Group M,59.7（5.1）s vs Group T,52.4（3.1）s）.Mild epistaxis was observed in 6 patients in Group M and 5 patients in Group T（6/30 vs 5/30,respectively）.No damage to oral tissue or teeth was observed in either group.No obvious nasal pain at each time point after extubation in the two groups.Conclusions We conclude that using a tube core,consisting of a disposable sterilised stylet,is a convenient choice for NTI. |
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