• Ying-Lun Tan, Zhu-Hao Wu, Bao-Jian Zhao, Yan-Hong Ni, and Ying-Chun Dong.
• From the Medical School of Nantong University, Nantong (YLT), Department of Oral Anesthesiology, Nanjing Stomatological Hospital (ZHW, BJZ, YCD) and Central Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China (YHN).
• Eur J Anaesthesiol. 2021 Nov 1; 38 (11): 118011861180-1186.

BackgroundNasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear.ObjectiveWhen both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia.DesignA systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time.Data SourcesPubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020.Eligibility CriteriaThe only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia.ResultsTen RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference -7.28 (-14.40 to -0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference -0.59 (-1.95 to 0.77) s, P = 0.40.ConclusionOn the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time.Trial RegistrationThe study protocol has been registered in PROSPERO (CRD42020169949).Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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