Cardiovascular responses and airway complications following awake nasal intubation with blind intubation device and fibreoptic bronchoscope: a randomized controlled study.

BACKGROUND AND

OBJECTIVE

The blind intubation device (BID) was introduced for awake nasotracheal intubation recently. The aim of this study was to compare the cardiovascular responses and associated airway complications of fibreoptic bronchoscope (FOB) with those of BID. The intubation attempts and intubation time were also compared.

METHODS

Forty-one ASA grade I or II normotensive adult patients with difficult airways, requiring nasotracheal intubation for elective oral and maxillofacial or plastic surgery, were randomly assigned to intubation with either FOB (n = 21) or BID (n = 20). The cardiovascular values were invasively measured at specific time points. Postoperative airway complications were assessed using a questionnaire.

RESULTS

Nasotracheal intubation was successful in both groups (100%). After sedation, blood pressure (BP) decreased significantly compared with baseline values in both groups (P < 0.05). Compared with baseline or postsedation values, both devices led to significant increases in BP when we inserted the endotracheal tube or the oesophagus airway through the nasal cavity (P < 0.05), while heart rate did not change significantly. Passing the FOB or light-guided catheter through the vocal cord and advancing the endotracheal tube into the trachea caused significant increases in both BP and heart rate compared with baseline or postsedation values (P < 0.05). No significant difference in BP or heart rate between the two groups was found. The intubation time was similar (P = 0.13). Blood detected on the intubation devices was similar in both groups (P = 0.73). Nasal pain, sore throat and hoarseness observed after 24 h was also similar (P = 0.49, 0.36, 0.51, respectively).

CONCLUSION

Both FOB and BID caused similarly slight cardiovascular responses during awake nasotracheal intubation in normotensive adults. The intubation-associated airway complications were similar.