| Part One:The feasibility study of rotating the tube under direct laryngoscope in nasotracheal intubationObjective:To assess the clinical effects of the using of Magill’s forceps (Magill’s method) and rotating the terminal of the tube (rotation method) in nasotracheal intubationMethods:A randomized controlled trial was used. One hundred ASA I or II patients requiring nasotracheal intubation for elective surgery at the cranio-maxillofacial Centre in Plastic Surgery Hospital from February to August2012were randomly allocated to1of2groups:the group of Magill’s method received Magill forceps; the group of rotation method received rotation of the tube,50cases in each group. In each group, intubation time, success rate, postoperative complications and hemodynamic changes were recorded.Results:Demographic date including age, gender, weight, BMI and ASA physical status were not significantly difference between groups. The group of Magill’s method and the group of rotation method have the same success rate, a hundred percent; time to glottis exposure was10.32±4.66s in the groups of Magill’s method as compared toll.16±5.68s in the group of rotation method(P>0.05); the intubation time in the groups of Magill’s method (26.58±11.80s) were significantly longer than that in the group of rotation method(21.48±8.29s)(P<0.05). The postoperative complications in the groups of Magill’s method were higher than those in the group of rotation method (P<0.05). Conclusion:The rotation method is a very safe and effective technique in nasotracheal intubation under direct laryngoscope. Compared with Magill’s method, the rotation method is simple and quick, with higher success rate and less complicationsPart two:The clinical research of rotating the tube under video laryngoscope in nasotracheal intubationObjective:To observe the effectiveness of nasotracheal intubation with Macintosh, Airtraq, and Tosight laryngoscope.Methods:A randomized controlled trial was used. One hundred and fifty ASA I or II patients requiring nasotracheal intubation for elective surgery at the cranio-maxillofacial Centre in Plastic Surgery Hospital from September2012to June2013were randomly allocated to1of3groups:group M received Macintosh laryngoscope, group A received Airtraq laryngoscope, group T received Tosight laryngoscope,50cases in each group. In each group, the Cormack-Lehane grading, glottic exposure time, time of advancing the tube and intubation, optimizing maneuvers, tentative number of tube to glottis, intubation frequency, postoperative complications and hemodynamic changes were recorded.Results:All patients were successfully completed nasotracheal intubation with rotation method. The rate of Cormack-Lehane grading I in group M, A and T was56%,100%and98%respectively (M vs. A, M vs. T, P<0.05), II was34%,0%and2%(M vs. A, M vs. T, P<0.05). The duration to glottic exposure:Group M and group A and group T was11.16±5.68s and9.92±4.05s and7.96±1.85srespectively(M vs. T, P<0.05). All patients succeeded in intubation with the first try except2patients performed twice in Group A. The duration to complete tracheal intubation:Group M and Group A and group T wasl.48 ±8.29s and21.72±12.34s and17.04±5.39srespectively(M vs. T, P<0.05).5patients in group M received maneuvers, but none in group A and T(M vs. A, M vs. T, P<0.05). First attempt success rate in group M, A and T was34%,70%and82%(P<0.05).Rate of patients suffering sore throat was32%,12%and8%in group M, A and T(M vs. A, M vs. T, P<0.05). The incidence in group A and T was significantly less than group M. The effects of intubation on hemodynamics among three group were all slight.Conclusion:All three laryngoscopes (Macintosh, Airtraq and Tosight)can be use to performing nasotracheal intubation successfully by rotation method. Compared with direct Macintosh laryngoscope, indirect Airtraq and Tosight laryngoscope are domestic laryngoscopes with good glottic visualization, reduction of optimizing maneuvers and postoperative sore throat.Besides, by the aid of Tosight,we can get a clear picture, convenience operations and short duration of exposure of glottis in nasotracheal intubation... |
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