Airway Exchange Catheter-guided versus Conventional Techniques of Nasotracheal Intubation: A Prospective Interventional Study

Introduction: The conventional Nasotracheal Intubation Technique (NTI), which involves the blind passage of an Endotracheal Tube (ETT) through the nose, is a potentially traumatic process. Airway Exchange Catheter (AEC) guidance for direct or Video Laryngoscopy (VLS) during NTI is likely to improve the first-attempt success rate, along with a reduced incidence of nasal trauma and bleeding. The primary objective is to assess the ease of ETT insertion into the oropharynx and trachea in terms of the number of attempts, navigability, and time taken for insertion. The secondary objectives are to assess the severity of bleeding, cuff rupture, and any other complications. Aim: To compare AEC-guided NTI with the conventional technique for successful NTI. Materials and Methods: This prospective interventional study was conducted in the main operation theatre complex of Government Medical College, Kozhikode, Kerala, India a tertiary care teaching hospital from January 2020 to August 2021 involving 70 patients who underwent oral and maxillofacial surgery. Patients were divided into two groups: group C (conventional NTI group) and group G (AEC-guided NTI group). The number of insertion attempts of the ETT into the oropharynx and trachea, navigability through the nasal passage, severity of bleeding, time taken for intubation, and incidence of cuff rupture were noted. Independent t-tests and Chisquare tests were used to compare variables. Results: The average age of patients in group G was 57.51 +/- 5.6 years, while in group C, it was 59.66 +/- 5.8 years. The results showed that ETT navigability was easier when using AEC, with a p-value of <0.01. There was a significant difference in the number of attempts for ETT insertion into the oropharynx and trachea (p<0.001). The total time taken for endotracheal intubation was significantly lower in group G compared to group C (p<0.01). The severity of bleeding was higher in group C, with 28.6% of intubations resulting in severe bleeding requiring suction, while the incidence was nil in group G. Conclusion: The first-attempt success rate was higher for the AEC-guided technique of NTI compared to conventional NTI. The incidence of complications was lower with AEC-guided techniques.