Suction Catheter as a Guide for Nasotracheal Intubation Under General Anesthesia

The goal of this clinical trial to study the efficacy of suction catheter guided technique and conventional technique during nasotracheal intubation.The main question areHow effective of the use of a suction catheter guided ETT in reducing bleeding during nasotracheal intubation?Does the use of a suction catheter guided ETT can improve its navigability through the nasal passage and reduce nasal passage time?

Inclusion Criteria:Patient undergoing elective oral and maxillofacial surgery in which nasotracheal intubation is preferred over orotracheal intubation to optimize surgical access.ASA physical status I-IIThai adult, aged 18-65 years oldNormal Body Mass Index (BMI = 18.5-24.9)Exclusion Criteria:Anticipated difficult airway (e.g., Mallampati classification 3-4, interincisal distance < 35 mm., thyromental length < 60 mm., limited neck mobility)Nasal infection or systemic infectionAbnormal coagulation status or having bleeding disorder or taking anticoagulation/antiplatelet medicationHistory of recurrent epistaxis since adulthoodAllergic rhinitis that necessitates the use of glucocorticoids, antihistamine, antileukotriene or decongestant in the past 4 weeksHistory of nasal trauma or abnormality (e.g., trauma in mid-face region, nasal surgery, nasal polyps, chronic sinusitis, abnormal nasal vasculature, tumor in nasal region, radiotherapy in nasal region)Craniofacial deformity syndromeUsing nasal oxygen or Continuous Positive Airway Pressure (CPAP)Previous nasotracheal intubation or nasogastric tube placement within 3 monthsDiagnosed as having a mental disorderDrop-out criteria:Unable to complete intubation procedureIntubation failed on both nostrilsWhen intubation was only possible with a tube smaller than 6.5 internal diameter (ID) in male and 6.0 ID in femaleInadequate data collection