Suction catheter as a guide for nasotracheal intubation under general anesthesia: randomized clinical trial of efficacy.

The aim of this study was to evaluate the efficacy of the suction catheter-guided ETT during NTI under general anesthesia. It was hypothesized that suction catheter guided method would reduce the injuries to nasal passage and improve the navigability. The study was designed as a single-site, randomized clinical trial with equal randomization (1:1), double-blinded (participants and primary outcome assessor) and parallel design.
The primary outcomes were the incidence and extent of bleeding. Records from the videolaryngoscope (GlideScope®) during intubation were reviewed. Only bleeding observed at posterior pharyngeal area, originating from trauma during the attempt to pass the ETT through the nasal passage, was accounted for. Bleeding was scored at its most severe state observed from the insertion to the removal of the videolaryngoscope after successful intubation, using a 4-point scale: 0 (no bleeding); 1 (blood-stained tube and/or cuff); 2 (blood-stained posterior pharyngeal wall; 3 (blood pooling at the posterior pharyngeal wall). Secondary outcomes included ease of navigation through the nasal passage, first-pass success rate, number of attempts, and nasal passage time. Ease of navigation was graded as follows: smooth (no resistance, no adjustments needed); slight resistance (resistance encountered, requiring manipulation more than once); and impinged (unable to pass through, requiring a change of nostril). The first-pass success rate was defined as the rate of successful nasal pass without changing nostrils. The number of attempts referred to the times the ETT needed to be withdrawn completely in order to find a new angulation, change nostrils or decrease the tube size before successful intubation. Nasal passage time was measured from when the ETT or suction catheter entered the anterior nares until the ETT passed into the pharynx or the suction catheter was completely withdrawn from the ETT.