Does Prewarming of Tracheal Tubes Prevent Epistaxis Following Nasotracheal Intubation? A Prospective, Randomised, Single‑Blind Study

Abstract

Introduction: Nasotracheal intubation has always been considered more traumatic than orotracheal intubation. According to previous studies, warming of endotracheal tubes is a good practice because it softens the tube and increases its flexibility, thereby resulting in less trauma. We aimed to study whether prewarming of nasotracheal tube resulted in less nasal trauma and epistaxis as compared with a tracheal tube at the room temperature. Our primary aim was to evaluate trauma and epistaxis due to nasotracheal intubation. The secondary aim was to observe the grade of epistaxis, ease of nasotracheal intubation, time taken to intubate, number of attempts to intubate and need for Magill’s forceps for intubation. Patients and Methods: This prospective, randomised, single‑blind study was conducted on 30 participants. Randomisation was done by a concealed envelope method. All participants belonged to the American Society of Anesthesiologists Physical Status I and II. They were allocated to one of two groups (n = 15 in each group). Patients in Group A were intubated with normal nasotracheal tubes at room temperature, while those in Group B were intubated with prewarmed nasotracheal tubes. The tracheal tubes were warmed at 45°C for 60 min. Institutional protocol for general anaesthesia was followed in both groups. Statistical analysis was performed using Medcalc software for Windows version 12.7.5.0. (Belgium). Results: Intubation was significantly easier in Group B (15) compared to Group A (5) (P < 0.0005). Time taken for intubation was significantly shorter in Group B (44.73 ± 11.02 s) as compared to Group A (74.46 ± 21.27 s) (P < 0.0001). The incidence of epistaxis was significantly higher in Group A (9) as compared to Group B (1) (P < 0.005).Conclusion: Incidence of epistaxis following nasotracheal intubation was significantly less with prewarmed tracheal tubes as compared to normal tracheal tubes.