An innovative technique for nasotracheal fiberoptic intubation using SNPA and its comparison with conventional technique: RCT.

Background: Awake nasotracheal fiberoptic intubation by conventional technique is time consuming and requires expertise. Complications encountered in the conventional technique sometime leads to procedure failure.

Objective: The primary aim of this study was to compare the innovative technique using split nasopharyngeal airway (SNPA) with the conventional technique for nasotracheal fiberoptic intubation in terms of time taken for intubation.

Method: This was a prospective, randomized, and single blind study conducted with 80 patients who were scheduled for maxillofacial surgery. Patients were randomized into two groups, group CFBI (conventional fiberoptic intubation) and group SNPA (split nasopharyngeal airway). In both the groups patients were prepared for awake fiberoptic naso-tracheal intubation. In Group CFBI (N = 41) awake naso-tracheal intubation was achieved by conventional technique of bronchoscope first approach. In Group SNPA (N = 39) spirally split nasopharyngeal airway was used first as a conduit for the passage of fiberoptic bronchoscope. The primary objective was to assess the time taken for intubation. The secondary objectives were to assess the rate of complications in the form of bleeding, cough, desaturation during the procedure, laryngospasm, and nasal bleeding.

Result: The time taken for intubation was 6.15 ± 3.0 minutes in CFBI group and 3.10 ± 1.35 minutes in SNPA group and this this difference was statically significant with value <0.001. Desaturation during the procedure was more in CFBI (99.46 ± 0.75) compared to SNPA (99 ± 0) group with significant difference value <0.001.

Conclusion: Split nasopharyngeal airway was used as conduit for the passage for the flexible fibreoptic bronchoscope and it considerably reduced the time required for fiberoptic nasotracheal intubation compared to the conventional technique of endotracheal tube first approach. Split nasopharyngeal airway provided better intubating conditions with lesser complications and superior patient comfort.