• Hyerim Kim, Jung-Man Lee, Jiwon Lee, Jin-Young Hwang, Jee-Eun Chang, Hyun-Joung No, Dongwook Won, Hyung Sang Row, and Seong-Won Min.
• Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
• BMC Anesthesiol. 2019 Aug 17; 19 (1): 158.

BackgroundClinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on the advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation.MethodsPatients were randomized to the 'neck extension group (E group)' or 'neutral position group (N group)' for this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the E group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patient's neck extended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was successfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned group, the case was defined as 'success.' We compared the success rate of tube advancement between the two groups.ResultsThirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube passage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%; odds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002).ConclusionNeck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.Trial RegistrationClinicalTrials.gov Identifier NCT03377114 , registered on 13 December 2017.

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