Nasotracheal intubation with the aid of nasopharyngeal airway

Introduction & objective: Oral and maxillofacial surgeries commonly require nasotracheal intubation (NTI) to overcome difficulty of work in the oropharyngeal space. Several variables affect intubation difficulty and complications and include tube type or design, topical vasoconstrictors, lubricating the endotracheal tube (ETT), selecting smaller diameter ETT, using urethral catheter to assist NTI, using some catheters etc. We aimed to explore the effectiveness of nasopharyngeal airway (NPA) as a factor facilitating the passage of ETT in the nasopharynx and diminishing trauma and bleeding during NTI. Methodology: One hundred-forty patients undergoing surgery in the oral and maxillofacial area were divided into groups of 70 each; NPA group, in which an NPA was used as an assist device, and non-NPA group with non-NPA use. Before intubation, the more patent nostril was identified, topical nasal vasoconstrictor was used, lubricant jelly applied and thermo softening of the ETT achieved. In NPA group, nasal cavity dilatation was done with an NPA before NTI. The ease of ETT passage and any nasopharyngeal bleeding were assessed by a scale of four grades. Results: About 95.71% patients had easy (grade 0 or 1) passage of ETT in the NPA group compared to 81.43% in the non-NPA group (P < 0.0001, P = 0.006), and the remaining grades also showing significant differences between groups. About 98.57% patients had grade 0 to 1 bleeding (no or traces of blood) in the NPA group, compared to 97.14% in the non-NPA group (P = 0.001) and the remaining grades also showed significant differences between the groups. NPA minimized difficulties in passage of the ETT and complications. Conclusion: Application of nasopharyngeal airway in patients undergoing nasotracheal intubation for general anesthesia proved to be effective in increasing nasal cavity space and minimizing difficulties faced in the passage of the endotracheal tube through the nasal passages and diminishing the resulting complications.