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Risk factors affecting the difficulty of fiberoptic nasotracheal intubation  

Rhee, Seung-Hyun (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Yun, Hye Joo (Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Kim, Jieun (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Karm, Myong-Hwan (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Ryoo, Seung-Hwa (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Kim, Hyun Jeong (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Seo, Kwang-Suk (Department of Dental Anesthesiology, School of Dentistry, Seoul National University)
Publication Information
Journal of Dental Anesthesia and Pain Medicine / v.20, no.5, 2020 , pp. 293-301 More about this Journal
Background: The success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI). Methods: FNI was performed by 18 anesthesiology residents under general anesthesia in patients over 15 years of age who underwent elective oral and maxillofacial operations. In all patients, the Mallampati grade was measured. Laryngeal view grade under direct laryngoscopy, and the degree of secretion and bleeding in the oral cavity was measured and divided into 3 grades. The time required for successful FNI was measured. If the intubation time was > 5 minutes, it was evaluated as a failure and the airway was managed by another method. The failure rate was evaluated using appropriate statistical method. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were also measured. Results: A total of 650 patients were included in the study, and the failure rate of FNI was 4.5%. The patient's sex, age, height, weight, Mallampati, and laryngoscopic view grade did not affect the success rate of FNI (P > 0.05). BMI, the number of FNI performed by residents (P = 0.03), secretion (P < 0.001), and bleeding (P < 0.001) grades influenced the success rate. The AUCs of bleeding and secretion were 0.864 and 0.798, respectively, but the AUC of BMI, the number of FNI performed by residents, Mallampati, and laryngoscopic view grade were 0.527, 0.616, 0.614, and 0.544, respectively. Conclusion: Unlike in intubation under direct laryngoscopy, in the case of FNI, oral secretion and nasal bleeding had a significant effect on FNI difficulty than Mallampati grade or Laryngeal view grade.
Difficult Intubation; Fiberoptic Nasotracheal Intubation; laryngeal View; Mallampati Grade; Risk Factors;
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