Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial

Study objective: To determine which nostril is more suitable for nasotracheal intubation in patients with normal patency of both nostrils.

Design: Prospective, randomized clinical trial.

Setting: Operating room of a university medical center.

Patients: 191 ASA physical status 1 and 2 patients scheduled for elective oral surgery requiring general anesthesia with nasotracheal intubation.

Interventions: Patients were randomized to two groups to undergo nasotracheal intubation through the right nostril (Group R; n = 96) or the left nostril (n = 95). Standard traditional nasotracheal intubation was performed using the Macintosh laryngoscope. Tube rotation was attempted for alignment toward the glottis, and Magill forceps were then used to assist intubation, as necessary.

Measurements: Epistaxis was inspected in the pharynx after the tube tip was passed through the nasal cavity and 15 minutes after nasotracheal intubation was completed. Intubation time was the interval between when the anesthesiologist opened the patient's mouth with the cross finger maneuver and when the tube was connected to the anesthetic circuit after nasotracheal completion.

Main results: The frequency of epistaxis was significantly lower in Group R than Group L (P = 0.0006). Although there was no significant difference in nasal passage time between two groups, the intubation time in Group R (24.5 ± 9.4 sec) was shorter than in Group L (30.5 ± 15.6 sec; P = 0.0015).

Conclusion: Nasal intubation via the right nostril is more safely performed than with the left nostril. Because of less epistaxis and faster intubation.