02 / Which nostril should be used for nasotracheal intubation with Airtraq NT: the right or left? A randomized clinical trial

Purpose: Nasotracheal Airtraq, is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Methods: After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18-70 years of age undergoing elective maxillofascial, oral and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomised into the right and left nostril groups. After standard anesthesia induction with propofol and fentanyl, rocuronium was used for muscle relaxation. Our primarily aim was to compare the glottis visualization time, intubation time and total intubation times. Demographic and airway management variables, Cormack-Lehane grades, the need for optimization, tube adjustment maneuvers (90uf0b0 anti-clockwise rotation, external laryngeal pressure, cuff inflation, head flexion, operator change and the use of Magill forceps in strict order), hemodynamic data, occurrence of epistaxis during the process were also recorded. Results: All intubations were performed by experienced user of the Airtraquf0d2 and the Airtraq NTuf0d2 Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NTuf0d2 (p<0.001). 90uf0b0 anti-clockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure can ease the intubation from the left nostril (p=0.001). Cuff inflation, head flexion maneuvers also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion: Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NTuf0d2 without the need of Magill forceps. We recommend the use of the 90uf0b0 anti-clockwise rotation maneuver and external laryngeal pressure to direct the tube into the vocal cords first. On the other hand; cuff inflation, head flexion maneuvers also must be kept in mind.