Does Use of a Soft Endotracheal Tube Reduce Epistaxis During Pediatric Oral and Maxillofacial Procedures?

Nasotracheal intubation (NTI) is frequently used during pediatric dental procedures performed under general anesthesia. However, the choice of nasal endotracheal tube (NET) can affect airway trauma and complications, such as epistaxis. The use of nasal Ring-Adair-Elwyn (RAE) may result in epistaxis. It remains unclear whether the use of spiral tubes (STs) can reduce epistaxis.

The purpose was to measure and compare the frequency of epistaxis between nasal RAE and spiral NETs in pediatric subjects undergoing dentoalveolar surgery.

A randomized, controlled, single-blinded trial, conducted at Dicle University Faculty of Dentistry (Diyarbakir, Turkey) hospital. The study population included pediatric subjects who underwent dental procedures. Eligible subjects were aged 3 to 18 years with American Society of Anesthesiologists physical status I-II. Subjects with anticipated difficult airway, coagulopathy, and contraindications to NTI were excluded.

The predictor variable was the type of NET. Subjects were randomly assigned to undergo NTI with either spiral (reinforced) or RAE tube.

The primary outcome variables were epistaxis incidence and severity during intubation. Epistaxis status was assessed immediately after intubation and 5 minutes later. Secondary outcomes were intubation time, intubation difficulty score, and the need for Magill forceps or the Sellick maneuver.

The covariates included demographics (age, sex) and anthropometric (height and weight).

Data were analyzed using χ² tests for categorical variables and independent-sample t tests for continuous variables. A P value<.05 was considered statistically significant.

The study sample comprised 96 subjects with a mean age of 6.33 (2.96) years, of 38 (40%) were male. The mean (SD) ages of the spiral and RAE group cohorts were 5.73 (2.81) and 6.94 (3.00), respectively (P < .01). Female/male ratio between groups was 25/23 and 33/15, respectively (P = .095). The frequency of epistaxis was statistically significantly lower in the ST group compared with the RAE tube group (33.3 vs 54.2%, P = .04). Intubation time was shorter in the ST group (29.0 ± 10.2 vs 34.1 ± 9.3 seconds, P = .005), and the need for Magill forceps was 15 (31.2%) in the ST group and 38 (79%) in the RAE group (P < .001). No severe complications were observed in either group.

Spiral NETs were associated with reduced epistaxis frequency and facilitated NTI compared with RAE tubes.