Nasopharyngeal airway effectiveness in reducing epistaxis prior to nasal intubation

Abstract

Nasotracheal intubation inherently carries the risk of epistaxis, which can impact patient safety, airway, and the overall surgical procedure. Epistaxis may occur during the intubation, obstructing the anesthetist's view of the vocal cords and complicating the procedure. The aim of this study is evaluated the efficacy of prophylactic nasopharyngeal airway (NPA) placement in mitigating the incidence and severity of epistaxis associated with nasotracheal intubation. A randomized controlled trial was designed to include 60 patients undergoing elective oral and maxillofacial surgery requiring nasotracheal intubation. Participants were randomly included in the intervention group (n=30), receiving prophylactic NPA placement, or the control group (n=30) without NPA. In the intervention group, a lubricated nasopharyngeal airway was inserted and maintained for two minutes before nasotracheal intubation. The NPA was removed, and standard nasal intubation with an endotracheal tube was performed. The primary outcome measure was the incidence and severity of epistaxis, assessed at two time points: immediately post-intubation and immediately post-extubation. The incidence of epistaxis after intubation was lower in the NPA group (13.3%) compared to the control group (36.6%, p = 0.037). The overall incidence and severity of epistaxis were also lower in the intervention group. Patients in the control group were over 4 times more likely to experience a higher grade of epistaxis compared to those who received nasopharyngeal tubes. In conclusion; pre-lubricated nasopharyngeal airway placement before nasotracheal intubation reduces the incidence and severity of epistaxis. This simple intervention can improve patient safety and optimize airway management during procedures requiring nasotracheal intubation.