Cuff inflation technique is better than Magill forceps technique to facilitate nasotracheal intubation guiding by GlideScope® video laryngoscope

Abstract

Video laryngoscopy is often selected to assist nasotracheal intubation in allowing better laryngeal visualization, although there is no comparative study evaluating the effectiveness between auxiliary techniques by using Magill forceps and inflated cuff in GlideScope video laryngoscopy for nasotracheal intubation. Fifty-one of 100 patients in a Magill forceps group and 47 of 100 patients in a cuff inflation group were included in the final analysis in this randomized, single-blind, parallel, clinical trial study. Induction agents were routinely administered according to body weight, while intubation time spent, attempts, and related side effects were recorded. Compared to the Magill forceps group, the cuff inflation technique shortened the total intubation time (70.0 ± 24.5 s vs. 87.0 ± 25.0 s, p = 0.001) and the time of advancing the nasotracheal tube from oropharyngeal space into the trachea (25.9 ± 16.4 s vs. 42.3 ± 21.2 s, p < 0.001). However, the number of intubation attempts was not significantly different between groups. During tube advancement, the tube was rotated to accommodate the glottis and trachea more frequently in the cuff inflation group (p = 0.009), but the blade of the laryngoscope shifted and was adjusted to the proper position more frequently in the Magill forceps group (p < 0.001). In the Magill forceps group, the tube cuff might be clipped incidentally and the intubator might shift their gaze away from the screen during intubation, although there was no significant difference in intubation-related side effects between groups. Unlike the conventional approach, nasotracheal intubation with the GlideScope ® video laryngoscope using the auxiliary technique of cuff inflation could be more suited than using Magill forceps.

Nasotracheal intubation with the aid of nasopharyngeal airway

“…24 The usage of tubes made of silicone, with a round soft tip, sterile lubrication, and water-soluble jelly can reduce epistaxis or nasal complications. 8,25 Finally, other tools that can be used during NTI include Magill forceps which have been developed over a century, 11,26 fiberoptic bronchoscope 16 and Parker Flex-Tip tracheal tube. 3 Taking into consideration the multiple factors and approaches to facilitate NTI that are mentioned, it might be better to conduct multiple studies in different hospitals and different cities with larger sample sizes to enable researchers to better explore the individual role of each approach alone, and the interaction between two or more approaches when applied together in a certain group of patients.…”

The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review

“…Inflating the cuff when the tube tip nears the entrance of the esophagus can shift the tip towards the glottis [ 35 36 ]. Once the tip passes through the glottis, the cuff is deflated and the tube is further advanced into the trachea.…”