Effects of Balloon on the Development of Epistaxis and Impingement during Nasotracheal Intubation

Abstract

BACKGROUND: Nasotracheal intubation may cause epistaxis, displacement of adenoids, polyps and intranasal foreign bodies, and bacteremia. So, the goal of this study is to see whether nasotracheal tube with balloon could reduce the incidences of epistaxis and impingement during nasotracheal intubation or not. METHODS: Eighty patients of ASA 1 or 2 classification, scheduled for oromaxillary surgical procedures, were randomly classified into two groups. 40 patients of each group received either nasotracheal RAE (Ring-Adair-Elwyn) tube only or nasotracheal RAE tube with balloon. Esophageal stethoscope was used to provide balloon. Each group was subdivided into two, one with intranasal spray of epinephrine solution 1:50,000 and the other one without intranasal spray of epinephrine solution. Intranasal spray of epinephrine was performed just before intubation. The incidences of epistaxis and the feeling of smooth passage of nasotracheal tube were compared between two groups. RESULTS: During nasotracheal intubation using nasotracheal RAE tube, 18 out of 40 patients without balloon and 9 out of 40 patients with balloon (P<0.05) were seen with epistaxis. Impingement during intubation was felt in 15 patients of group without balloon and in 7 patients of group with balloon (P<0.05). Those results did not differ significantly between the subgroups with and without intranasal spray of epinephrine solution. CONCLUSIONS: We concluded that nasotracheal RAE tube with balloon reduce the incidences of epistaxis and impingement during nasotracheal intubation, but intranasal spray of epinephrine solution 1:50,000 show no influence to reduce the incidence of epistaxis. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]