The use of a FROVA airway intubation introducer as a guide before nasotracheal intubation could improve insertion condition

Background: Numerous complications are related to nasal intubation. Objective: This study compared the efficacy of the FROVA catheter-guided technique to the conventional blind approach in reducing epistaxis occurrences and improving nasal airway provision. We hypothesized that compared with the conventional approach, using the FROVA catheter would have a 30 % higher incidence of successful intubation without epistaxis. Methods: This was a randomized trial conducted under single-blind conditions. Only asymptomatic patients with easy nasal breathing who underwent maxillofacial surgery with nasotracheal intubation, aged 18 to 65, and had ASA I and II physical status were involved. Patients were allocated into the conventional (n = 50) and FROVA groups (n = 50). Results: All patients had successful tracheal tube insertions through the chosen nostril. Patient demographics and preop evaluations were similar. The FROVA-guided method was superior to the conventional method regarding the incidence of epistaxis after nasotracheal intubation. The FROVA group exhibited a substantially reduced incidence of epistaxis, with an absolute risk reduction of 52 % (95 % confidence interval: 36.18-67.82; P-value <0.001) and required fewer manipulations (p < 0.001). Also, less epistaxis severity through intubation was reported in the FROVA group (p < 0.001). The FROVA group had a higher incidence of tracheal tubes in the lower nasal passage (p < 0.001). Conclusions: Guiding the tracheal tube through the nasal cavity using a FROVA catheter has improved insertion conditions and reduced the severity and occurrence of epistaxis.