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Pilot Study Comparing Nasal vs Oral Intubation for Dental Surgery by Physicians, Nurse Anesthetists, and Trainees.

Abstract

The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time ( p = .603) or total case time ( p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) ( p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment ( p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience.

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  • Authors+Show Affiliations

    ,

    Private Practice Pediatric Dentistry Bowling Green, Ohio.

    ,

    Assistant Professor and Director Advanced Education in Pediatric Dentistry, Department of Surgery, Division of Dentistry, University of Toledo Medical Center, Toledo, Ohio.

    ,

    Assistant Professor, Department of Anesthesiology, University of Toledo Medical Center, Toledo, Ohio, and.

    Assistant Professor and Director General Practice Residency, Department of Surgery, Division of Dentistry, University of Toledo Medical Center, Toledo, Ohio.

    Source

    Anesthesia progress 65:2 2018 pg 89-93

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29952648

    Citation

    TY - JOUR T1 - Pilot Study Comparing Nasal vs Oral Intubation for Dental Surgery by Physicians, Nurse Anesthetists, and Trainees. AU - Bowman,J Patrick, AU - Nedley,Michael P, AU - Jenkins,Kimberly A, AU - Fahncke,Charles R, PY - 2018/6/29/entrez PY - 2018/6/29/pubmed PY - 2018/6/29/medline KW - Oral intubation dental KW - Pediatric general anesthesia SP - 89 EP - 93 JF - Anesthesia progress JO - Anesth Prog VL - 65 IS - 2 N2 - The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time ( p = .603) or total case time ( p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) ( p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment ( p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience. SN - 1878-7177 UR - https://www.unboundmedicine.com/medline/citation/29952648/Pilot_Study_Comparing_Nasal_vs_Oral_Intubation_for_Dental_Surgery_by_Physicians,_Nurse_Anesthetists,_and_Trainees L2 - http://www.anesthesiaprogress.org/doi/10.2344/anpr-65-02-07?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed ER -