Tracheal intubation is a vital and common procedure during surgical care. The tracheal tube may be inserted orally or trans-nasally. Nasal intubation enables a non-restricted approach for oral and oropharyngeal regions. Thus, nasotracheal intubation is more suitable for surgeries such as uvulopalatopharyngoplasty treating obstructive sleep apnea. Obstructive sleep apnea is an independent risk factor for postoperative cardiorespiratory complications. Thus, meticulous treatment during and post-operatively is needed keeping the upper airway open including the nasal cavity. In several studies, nasotracheal intubation resulted in disruption of the nasal mucosa.
The objective of this study is evaluating the developing nasal resistance post nasotracheal intubation and comparing it to nasal resistance post-orotracheal intubation. To our knowledge, this is the first data on nasal obstruction following nasal intubation.
Forty-four candidates, for elective non-head and neck procedures were randomized into two groups: oral intubation group and nasal intubation group. The nasal resistance of all participants was measured by anterior rhinomanometry upon the recommendation of the standardization committee on objective assessment of the nasal airway. Statistical analysis with paired T test, Chi square and McNemar’s test was performed. Statistical significance was evaluated at P≤0.05.
There were no differences between the study groups regarding nasal resistance before and after intubation. However, nasotracheal intubation was found to disrupt the normal nasal cycle of the nasal mucosa.
Nasotracheal intubation does not negatively affect nasal resistance in the early postoperative period.
Nasotracheal intubation does not affect nasal resistance and it seems to be safe for OSA patients. More research has to be conducted to evaluate the nasal resistance in patients who undergo oral and nasal surgeries.