Value of ultrasound-guided nasotracheal intubation in patients undergoing oral maxillofacial surgery: a comparison with blind intubation

Objective To evaluate the value of ultrasound-guided nasotracheal intubation in the patients undergoing oral maxillofacial surgery by comparing with blind intubation. Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes, aged 18-75 yr, weighing 45-90 kg, scheduled for elective oral maxillofacial surgery, were randomly divided into blind intubation group (group B, n = 20) and ultrasound group (group U, n = 20) according to a random number table.Nasotracheal intubation was performed after routine topical analgesia and conscious sedation.The front end of catheter was adjusted to the aditus glottidis according to the sound of respiratory air, and tracheal intubation was placed when the strongest inspiratory phase appeared in group B. A linear array probe (frequency 7-15 MHz) was used, and the images of glottis expansion and wired catheter insertion were visualized in the thyroid cartilage window in U group.Before intubation and at 0, 1, 3 and 5 min after successful intubation, mean arterial pressure (MAP), HR and SpO2 were recorded.The development of responses to intubation was recorded during intubation.The successful intubation at first attempt, the number of intubation, intubation time, and postoperative complications such as sore throat or hoarseness were recorded. Results Compared with group B, the number of intubation was significantly reduced, intubation time was shortened, the rate of successful intubation at first attempt was increased, the failure rate of intubation and incidence of sore throat and hoarseness were decreased, and no significant changes were found in the parameters of hemodynamics and incidence of responses to intubation in group U. No intraoperative awareness of intubation occurred in patients. Conclusion Compared with blind intubation, ultrasound-guided nasotracheal intubation can raise the probability of successful intubation at first attempt, reduce the number of intubation, and shorten intubation time, and it is safe and convenient and provides significant value clinically for the patients undergoing oral maxillofacial surgery. Key words: Intubation, intratracheal; Nasal cavity; Ultrasonography