Fibrescope vs Videolaryngoscope for Nasotracheal Intubation

NCT07353255 | Not Yet Recruiting

• 1 other identifier: 343162
• Study Type: interventional
• Target: 200
• Locations: 0 countries
• Sites: N/A

Brief Summary

Patients having surgery under general anaesthesia require insertion of a breathing tube to keep the airway open. The technique of inserting a breathing tube through the nose into the trachea (airway) is known as nasotracheal intubation. This is the ideal airway for surgical procedures performed inside the mouth such as complex teeth extractions and operations on the jaw. Traditionally, the breathing tube is initially inserted blindly into the nasal cavity, then a video laryngoscope (a camera device) or a direct laryngoscope is used to visualise and guide the passage of tube into the trachea. This approach can be associated with difficulty passing the tube and a has high incidence of nasal trauma and nosebleed. A flexible fibrescope ( flexible camera device) with pre-loaded tracheal tube is passed through the nostril first under vision, gently advanced through the nasal passage and then to the trachea. Once it is correctly placed in the trachea, the breathing tube is railroaded over it. This procedure allows to visualise the nasal passage and to choose most patent nostril and hence likely to reduce risk of nosebleed as compared blind passage of tube through the nose. A videolaryngoscope has a camera on the blade that projects the image onto a monitor screen. As this is a rigid device, it can only be inserted through the oral cavity and allows the advancement of tube into the trachea. Both these techniques are currently used in the clinical practice. However, there are no studies to inform the anaesthetists whether there are any differences in the incidence of nosebleed. We wish to do a randomised comparison between flexible fibrescope and videolaryngocope in terms reducing the risk and severity of nosebleed. Patients aged 18 and above, presenting for elective surgical procedures and requiring general anaesthesia and nasal intubation will be invited to take part in the study. We are aiming to recruit 200 participants (see sample size section) to see any significant differences in the incidence of nosebleed. Patients who are eligible and consent to take part in the study will be randomly allocated either to flexible fibrescope group or to videolaryngoscope. At the time of nasotracheal intubation, smoothness of nasal intubation, severity of bleeding from the nose and time taken to complete the tracheal intubation will be noted. Five minutes after intubation, the surgeon performing surgery (blinded to the technique of intubation) will be examining the oral cavity for any bleeding. This will be graded using a standardised nasal bleeding score. All patients will be visited in the post operative period to check any ongoing nosebleed and nasal discomfort. Patient details that will be collected includes gender, age, weight, height, body mass index and airway assessment parameters. No other personal data is required. This study aims to see whether the use of flexible fibrescope reduces nasal bleeding and improves patient safety. If there is no difference, it may provide reassurance in the continued use of video laryngoscopy for nasal intubation.

Conditions

No Disease

Outcome Measures

Primary Outcomes (1)

• Nasal trauma score

  a score of 0 to 3 will be provided no bleeding, moderate bleeding, or severe bleeding

  5 minutes

Secondary Outcomes (5)

• nasal intubation smoothness score

  2 minutes

• Total intubation time

  2 minutes

• Laryngoscopy time

  2 minutes

• incidence of post operative sore throat

  24 hours

• incidence of postoperative nasal discomfort

  24 hours

Study Arms (2)

Flexible Fibrescope

ACTIVE COMPARATOR

Randomly allocated to have intubation using flexible fibrescope

Device: Nasotracheal Intubation with Fibrescope

Videolarygoscope

ACTIVE COMPARATOR

randomly allocated to have intubation using videolaryngocope

Procedure: Nasotracheal Intubation with Video laryngoscope

Interventions

Nasotracheal Intubation with Fibrescope DEVICE

Intubation of trachea via nasal route with Fibrescope (11302BDX Flex. Intubation Video Endoscope 4 x 65 Karl Storz)

Flexible Fibrescope

Nasotracheal Intubation with Video laryngoscope PROCEDURE

Intubation of trachea via nasal route using a videolaryngoscope (301-000-000 McGRATH™ with Mac Blade)

Videolarygoscope

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged 18 and above, presenting for elective surgical procedures and requiring general anaesthesia and nasal intubation will be invited to take part in the study.

You may not qualify if:

• Patients who do not want to take part or do not give consent
• Patients unable to give written consent.
• Patient physical status of ASA 4 and 5,
• Patients deemed to require awake intubation.

Sponsors & Collaborators

• University Hospitals Coventry and Warwickshire NHS Trust: lead

Related Publications (6)

• Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014 Jun;59(6):865-78; discussion 878-80. doi: 10.4187/respcare.03012.

  PMID: 24891196 BACKGROUND

• Bansal T, Singhal S, Dhingra K. A study to evaluate nasotracheal intubation using Airtraq laryngoscope with a bougie and without a bougie. Indian J Anaesth. 2022 Nov;66(11):757-762. doi: 10.4103/ija.ija_466_22. Epub 2022 Nov 18.

  PMID: 36590192 BACKGROUND

• El-Seify ZA, Khattab AM, Shaaban AA, Metwalli OS, Hassan HE, Ajjoub LF. Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth. 2010 Oct;105(4):501-5. doi: 10.1093/bja/aeq205. Epub 2010 Aug 3.

  PMID: 20682569 BACKGROUND

• Kim YC, Lee SH, Noh GJ, Cho SY, Yeom JH, Shin WJ, Lee DH, Ryu JS, Park YS, Cha KJ, Lee SC. Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg. 2000 Sep;91(3):698-701. doi: 10.1097/00000539-200009000-00038.

  PMID: 10960403 BACKGROUND

• Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth. 2006 Mar;53(3):295-8. doi: 10.1007/BF03022218.

  PMID: 16527796 BACKGROUND

• Abrons RO, Zimmerman MB, El-Hattab YMS. Nasotracheal intubation over a bougie vs. non-bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy. Anaesthesia. 2017 Dec;72(12):1491-1500. doi: 10.1111/anae.14029. Epub 2017 Sep 15.

  PMID: 28921537 BACKGROUND

Study Officials

• Cyprian Mendonca

  University Hopsitals Coventry & Warwickshire NHS Trust

  STUDY DIRECTOR

Central Study Contacts

Charles Pairaudeau, FRCA

CONTACT

+44719121363; Charles.Pairaudeau2@uhcw.nhs.uk

Maria Turslove

CONTACT

+442476966053; ResearchSponsorship@uhcw.nhs.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 13, 2026
• First Posted: January 20, 2026
• Study Start: January 16, 2026
• Primary Completion (Estimated): January 31, 2027
• Study Completion (Estimated): January 31, 2027
• Last Updated: January 20, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share