Modified nasopharyngeal airway device facilitates nasal fiberoptic intubation for trainee anesthesiologists: a randomized clinical study

Abstract

Fiberoptic nasotracheal intubation is an essential skill for anesthesiologists. Trainee anesthesiologists often face challenges due to the complex anatomy of the nasopharynx and the risk of upper airway collapse after anesthesia administration, which can lead to confusion and difficulty in identifying the glottic opening. This study evaluated whether a modified nasopharyngeal airway (mNPA) device can assist less experienced operators in performing nasal fiberoptic intubation on anesthetized patients with non-difficult airway. This randomized controlled trial analyzed 54 patients undergoing elective surgery with nasal intubation. The patients were then assigned to either the mNPA group ( n = 28) or the conventional nasal fiberoptic intubation (cNFI) group ( n = 26). In the mNPA group, a modified airway guided the flexible fiberoptic bronchoscope to the glottis, and the device was subsequently removed to facilitate intubation. Trainee anesthesiologists performed all intubations. The primary outcome was intubation time. The secondary outcomes included first-attempt success rate and bleeding complications. The mNPA group had a significantly faster vocal cord visualization time (11.49 vs. 47.56 s, P < 0.001) and a shorter intubation time (56.25 vs. 107.02 s, P < 0.001) than the cNFI group. The mNPA group had a significantly higher first-attempt success rate (96.43% vs. 73.08%, P value = 0.038) and a significantly lower incidence of blood staining in the periglottic area (3.57% vs. 26.92%, P value = 0.022) than the cNFI group. The mNPA significantly improved nasotracheal intubation time and success rates and reduced the number of attempts and bleeding complication rates for operators with limited experience in performing nasal fiberoptic intubation in non-difficult airway patients. Thai Clinical Trials Registry TCTR20230809006. Registered 9 August 2023.