Comparison of two different methods of fiber-optic nasal intubation: conventional method versus facilitated method (NASAL-18)

OBJECTIVES: As the conventional fiber-optic nasal intubation technique has several potential difficulties, we compared in this study another technique (NASAL-18) with the conventional one in attempting fiber-optic nasal intubation with a possible higher rate of success. METHODS: A randomized controlled trial was carried out at a teaching hospital. Forty-eight patients aged 25–45 years with American Society of Anesthesiologists (ASA) classes I and II undergoing elective faciomaxillary surgery were allocated to two groups of fiberscopic nasal intubation using either the NASAL-18 technique or the conventional method (control). In the NASAL-18 group, a nasal tube was gently inserted into the nasopharynx till mark 18, then a fiberscope with 41 cm length was glided over it and advanced through the nasal cavity till the glottis could be visualized. Finally the nasal tube was rolled over the fiberscope instead of one-step passage of the nasal tube after visualization of glottis in the controls. Times from the start of insertion of the fiberscope into nares till visualization of vocal cord (T1) and from here to complete intubation (T2) were recorded. These times were compared between the two groups. RESULTS: T1 values in NASAL-18 and control groups were 65.2 ± 33.2 and 151.0 ± 56.5 seconds, respectively (P < 0.0001). T2 durations were measured as 25.1 ± 18.5 and 21.8 ± 10.1 seconds in control and NASAL-18 groups, respectively (P = 0.45). The NASAL-18 group had a success rate of 83% compared to 66.7% in the control group. CONCLUSIONS: The NASAL-18 method reduces the time needed for successful fiber-optic intubation. This method can be added to the list of techniques in facilitating fiber-optic intubation.