Establishment of Evidence-based Nasotracheal Intubation Methods

Abstract

  This paper explores five key aspects of nasotracheal intubation (NTI) from an evidence-based perspective, rather than relying on traditional experience-based methods : (1) disinfection methods, (2) choice of hemostatic agents, (3) intubation routes, (4) selection of laryngoscopes, and (5) pressure ulcer prevention. Studies have shown that benzalkonium chloride (BZK) offers superior sustained antimicrobial effects, compared with povidone-iodine (PVI), making it a promising choice for reducing the risk of bacteremia. Both epinephrine (E) and tramazoline (T) have demonstrated an equivalent efficacy in controlling nasal bleeding, with no significant safety differences observed. Regarding intubation routes, using the right nostril reduced the frequency of nasal bleeding and shortened the intubation times, compared with the left nostril, probably because of anatomical advantages. The McGrath MAC laryngoscope improved visualization and reduced intubation times, compared with the Airwayscope and Macintosh laryngoscopes, with a superior usability reported by both inexperienced and skilled practitioners. Lastly, 3M Microfoam^TM surgical tape (3ST) effectively prevented nasal pressure injuries associated with NTI, offering a cost-effective alternative to hydrocolloid products. These studies demonstrate the potential of various methods and tools for improving the safety and efficiency of NTI. However, several research limitations exist, including restrictions in patient populations, study design constraints, and the lack of control groups. Further research is necessary to address these issues. Moving forward, these findings are expected to contribute to the establishment of standardized NTI techniques and the implementation of safer and more effective airway management methods based on scientific evidence.