Glottic view, tube-advancement techniques, and airway events during videolaryngoscopic nasotracheal intubation in adults with special healthcare needs: a prospective observational study

Abstract

Airway management in adults with special healthcare needs undergoing dental treatment under general anesthesia may be challenging because of limited cooperation, heterogeneous diagnoses, and difficulties in awake airway assessment. The Percentage of Glottic Opening (POGO) score quantifies glottic visualization, but its relationship with nasotracheal tube advancement in this population remains unclear. This study aimed to describe videolaryngoscopic glottic visualization, total nasotracheal intubation duration, nasotracheal tube-advancement techniques, and airway-related events during nasotracheal intubation. This prospective descriptive observational study included 100 adults with special healthcare needs undergoing dental treatment under general anesthesia. Videolaryngoscopic nasotracheal intubation was performed in all patients. POGO score, modified Cormack–Lehane grade, Han mask ventilation grade, total nasotracheal intubation duration, first-attempt success, airway optimization maneuvers, nasotracheal tube-advancement techniques, and airway-related complications were prospectively recorded. Total nasotracheal intubation duration was analyzed as a continuous variable and categorized as ≤ 30 s, 31–60 s, and > 60 s; >60 s was defined as prolonged nasotracheal intubation. Spearman correlation, Mann–Whitney U, Chi-square, and Fisher’s exact tests were used as appropriate. The median POGO score was 100 [75–100], and first-attempt intubation success was achieved in all patients. The median total nasotracheal intubation duration was 38.0 [28.0–49.3] seconds. Intubation was completed within 30 s in 40 patients (40.0%), between 31 and 60 s in 48 patients (48.0%), and lasted longer than 60 s in 12 patients (12.0%). POGO score was not significantly correlated with total nasotracheal intubation duration or post-induction airway measurements. Nasotracheal tube-advancement techniques were frequently used, including cuff inflation in 80.0% and anticlockwise tube rotation in 75.0%. Magill forceps use and anticlockwise tube rotation were more frequently recorded during prolonged intubations. In this selected single-center cohort managed by experienced anesthesiologists, videolaryngoscopic nasotracheal intubation was completed successfully on the first attempt in all observed cases and was associated with favorable glottic visualization. However, POGO score was not associated with total nasotracheal intubation duration, and nasotracheal tube-advancement techniques were frequently applied. These findings suggest that glottic view alone may not fully capture the procedural complexity of videolaryngoscopic nasotracheal intubation. Not applicable.