Split Nasopharyngeal Airway, a Tracking Tool for Fibreoptic Nasotracheal Intubation: A Randomised Controlled Study

Abstract

Introduction: Managing a challenging airway in awake, sedated, or anaesthetised patients has made Fibreoptic Intubation (FOI) using a flexible Fibreoptic Bronchoscope (FOB) a mainstay in clinical practice. Aim: To evaluate and compare fibreoptic nasotracheal intubation with or without Split Nasopharyngeal Airway (SNPA) as a conduit, focusing on time taken, ease of insertion, and haemodynamic changes. Materials and Methods: This randomised controlled study was conducted at the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India, on 80 patients who were randomly allocated into two groups: Group CL (the control group without SNPA) and Group NP (with SNPA). Both groups were induced with general anaesthesia, and nostrils were prepared for FOB. In Group CL, a well-lubricated FOB was inserted into the selected nostril without using SNPA, and endotracheal intubation was performed. In Group NP, an appropriately sized SNPA was lubricated and inserted into the selected nostril. The fiberscope was passed through the SNPA, the vocal cords were visualised, and the SNPA was removed before railroading the preloaded tube through the vocal cords to confirm correct placement. The time taken for bronchoscopy and intubation, ease of insertion, haemodynamic parameters, and bleeding were recorded in both groups. The data was coded, entered, and analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. A significance level was set at a p-value ≤0.05. Results: Demographic data, including age and gender distribution, mean weight, height, Body Mass Index (BMI), and airway parameters such as Mallampati grading, neck circumference, inter-incisor distance, and ASA grading, were standardised. There was no significant difference between the CL and NP groups regarding these parameters. The time taken for FOB and intubation in Group CL was 2.59±0.96 minutes and 3.61±1.04 minutes, respectively, compared to 1.87±0.91 minutes and 2.51±0.86 minutes in Group NP (p-value=0.001). The time taken to visualise the glottis was also shorter in the NP group (6.70±13.97 minutes) compared to the CL group (24.02±13.06 minutes), which was significant. Fibreoptic bronchoscopy was considered easy in 16 patients (40%) in Group CL and 27 patients (67.5%) in Group NP (p-value=0.04). The increase in mean arterial blood pressure was significantly higher in Group CL than in Group NP just after the insertion of the FOB into the nasopharynx (p-value=0.05). Conclusion: Fibreoptic nasotracheal intubation through an SNPA is less time-consuming and results in easier intubation. It causes less trauma to the nasal passage and leads to fewer haemodynamic variations in terms of mean arterial pressure and heart rate. Hence, SNPA is a better method for facilitating FOI compared to intubation without it.

Keywords

• difficult airway
• endotracheal tube
• fibreoptic bronchoscope
• fibreoptic intubation