Abstract:

Objective This study aims to compare the efficacy of video stylets and video laryngoscopes in facilitating nasotracheal intubation during oral surgery. Methods A total of 80 patients， aged between 18 and 70 years old， with ASA grade Ⅰ or Ⅱ， scheduled for elective oral surgery under general anesthesia， were randomly assigned to either the video stylet group （Group N） or the video laryngoscope group （Group C）， with 40 patients in each group. In Group N， a video stylet was used to shape the tracheal tube at a 90-degree angle， with the shaping position being the vertical distance from the Adam's apple to the nostril. The tube was inserted from the nasal cavity into the throat under direct visualization， and positioned behind the glottis. In Group C， the tube was initially blindly inserted into the nasal cavity without a core. Upon reaching the throat， a video laryngoscope was employed to lift the epiglottis and expose the glottis from the mouth. The tube was then inserted with the aid of intubation forceps or cuff inflation. The primary outcome measure was the intubation time. Additional measures included the time taken for nasal passage， glottis exposure， and the number of intubation attempts and assistant interventions required. Vital signs， including MAP and HR， were recorded at five minutes of quiet rest upon entering the room （T₀）， during glottis exposure （T₁）， upon passage of the tube through the glottis （T₂）， and one minute after the tube entered the trachea （T₃）. Complications such as epistaxis， oral mucosal bleeding， loose incisors， and postoperative sore throat were also documented. Results The intubation time and nasal passage time in Group N were significantly shorter than those in Group C （P < 0.05）. The number of cuff inflations and intubation forceps assisted cases in Group N was significantly lower than in Group C （P < 0.05）. There were no significant differences between the two groups in terms of glottis exposure time， first successful intubation times， C-L glottis classification， and mandibular lift-assisted intubation （P > 0.05）. The increase in MAP and HR in Group N at T₁ and T₂ was significantly less than in Group C （P < 0.05）. The number of cases with mild epistaxis in Group N was significantly lower than in Group C （P < 0.05）. Similarly， the number of cases with loose incisors and oral mucosal bleeding in Group N was significantly less than in Group C （P < 0.05）. Conclusion Compared to the video laryngoscope， the video stylet-guided nasotracheal intubation results in a shorter intubation time， less damage to the oronasopharynx， eliminates the need for intubation forceps， and reduces the patient's stress and vascular stress response during intubation.

Key words: video stylet, video laryngoscope, nasotracheal intubation, nasopharyngeal cavity care