Common Nasal Anomalies and Its Implications on Intubation in Head and Neck Surgeries

Abstract

Nasotracheal intubation used to be the preferred route for prolonged intubation in critical care units. Nasotracheal intubation may sometimes cause nasal trauma. The study included one hundred and nine (109) adult patients, were scheduled for elective head and neck surgeries with general anaesthesia, requiring nasotracheal intubation. All the patients compiled the criteria of American Society of Anesthesiologists (ASA) physical status I and II were included in this study. The incidence of complicated laryngoscopy was assumed as 8%, confidence levels at 99% and an error of 3%, the total sample size were One hundred and three (103) patients. Observation, recorded bleeding 63.11% (65-patients) of the time with the literature stating epistaxis rates from 17-77%. The study found there was a significant relationship of soft tissue profile and number of intubation attempts. In this study a concave profile was more likely to have multiple attempts, there was a significant relationship between moderate and severe bleeding and number of intubation attempts and in 04.85% (05-patients) of those patients with severe bleeding there were multiple intubation attempts. Thyromental distance and Mallampati score did not seem to have a significant relationship with either the number of intubation attempts or severity of bleeding. This may demonstrate that multiple attempts led to an increase in bleeding due to increased trauma or that bleeding from the nose into the oropharnyx and hypo-pharynx contributed to a difficult view of the larynx for passing the tube between the cords. The clinical relevance from this study to create an algorithm or define a set of factors to alert anesthetists to aware of knowledge about the common nasal anomalies for the difficult nasotracheal (NT) intubation.

A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

“…Ramadhani reported sternomental distance as an indicator of head and neck mobility in 1996 (22). One study reported a signi cant difference in this anatomical distance between the single and multiple-attempt laryngoscopy groups (23). However, our study did not compare single and multiple attempts, and several factors, such as the di culty in evaluating neck mobility, may affect the results.…”