Using a rubber catheter introducer reduces epistaxis during nasal intubation

Objective: Nasal-tracheal intubation is conducted routinely for pediatric dental general anesthesia. Epistaxis is often a complication of introducing the plastic tube into the nasal passage. In the hospital environment tubes are often softened prior to introduction of the endo-tracheal tube (ETT). In the office environment, warmers are not available and alternative methods need to be used. This study evaluates the use of a rubber uretheral catheter as an introducer of ETT to reduce epistaxis. Methods: Children ages 18 months-12 years old who were scheduled for oral rehabilitation under intubated general anesthesia were divided randomly into two groups. Group one received nasal intubation using the appropriate size tube after induction of general anesthesia with the standard protocol oxymetazoline spray, nasal dilation using nasal-pharyngeal airways followed by the introduction of ETT. Group two received the same standard protocol with the addition of using an 8 or 10 French red rubber uretheral catheter to shield the tip of ETT while introducing it through the nasal passage. The presence or absence of blood in the oral pharynex was evaluated and quantified by the anesthesiologist during laryngoscopy. A score of 0-4 was assigned based on the amount of blood noted. 0=no bleeding, 1=<0.5 cc, 2=1-2 cc's 3=2-3 cc's 4=>3cc's. Results: Epistaxis scores were lower in group 2 compared to group 1 Conclusions: Using a red rubber catheter as an introducer might be useful in reducing bleeding during nasal-tracheal intubation. Larger studies are needed to validate this technique.