Magill forceps is used to maneuver the endotracheal tube (ETT) in the posterior
oropharynx and place its tip into the laryngeal inlet. While the Magill forceps are
useful in guiding the nasotracheal tube past the vocal cords, care must be taken to avoid
excessive maneuvering in order to minimize the risk of local trauma and rupture of the
nasotracheal tube balloon.
Cuff inflation-deflation method can reduce the apnea time in the adult patients. This, in
turn, could point to a reduction in the complications (as desaturation and cardiac
arrhythmia) that associated with the prolonged-time procedure.
Written informed consent will be obtained from all patients participating in the trial.
The trial will be registered prior to patient enrollment. Ninety patients between the
ages of 18 and 60 years with American Society of Anesthesiologists (ASA) physical status
I -II , scheduled for elective surgery (dental and maxillofacial) will be enrolled in a
prospective randomized observer blinded clinical trial. Patients, who have
coagulopathies, have upper airway abnormalities, at risk for aspiration or patient's
refusal will be excluded from the study.
Materials and methods
Airway management is subdivided into phases:
Phase 1 :Passage of the endotracheal tube through the nose into the pharynx Phase 2 :
Video-laryngoscope-guided passage of the endotracheal tube through the pharynx into the
trachea.
Patients will be randomized into 2 groups according to phase 2:
Group A (45 patients) will be performed with tracheal tube cuff inflation-deflation
method. Tracheal tube cuff will be inflated with 15-20 ml of air (volume of air is
depending on the level of larynx). Once the tip of ETT at the laryngeal inlet, the cuff
of ETT will be deflated and advanced into the trachea.
Group 2 (45 patients) will be performed using the Magill forceps to guide the ETT tip to
pass through the pharynx and glottis into the trachea.
Patients will be randomly assigned on a one-to-one ratio. Randomization will be performed
outside the study center by means of a computer generated random- numbers table. Group
allocation will be concealed in sealed opaque envelopes that will not be opened till the
last practical moment.
The nasal intubation will be performed behind an opaque screen so that observer could not
see which approach will be used. All procedures were performed preoperatively by the
attending anesthetists, who have the same substantial expertise (at least 3 years) in the
video laryngoscopy assisted nasal intubation in adult patients. Patient demographics,
type and duration of surgery, and the patient's ASA physical status will be recorded.