A comparative study of intubating condition and hemodynamic changes during blind nasal intubation versus fibre optic intubation in cases of temporo-mandibular joint ankylosis

Background: Preservation of patient’s spontaneous respiration and consciousness are most important recommendations in any one of difficult airway. Under adequate upper airway block, awake intubation could be performed through oral or nasal routes using fibre optic visualization or blind nasal techniques. This work was designed to compare the applicability of awake blind nasal intubation and that of fibre optic naso-trachael intubation.  Materials and Methods: Sixty patients were distributed randomly into two groups of thirty patients each, Group A (fibre optic intubation) and Group B (Blind nasal intubation) After pre-operative evaluation, patients in both the groups were given lidocaine nebulisation 4% (5ml) and bilateral SLN and RLN blocks. Patients were intubated with fibre optic and blind nasal intubation techniques according to their groups. Tube placement in trachea was confirmed by ETCO2. In both the groups, comparison regarding time taken for intubation, no of attempts of intubation, hemodynamic changes and side effects / complications were done. Results: Intubation time in group A was significantly less than that of group B. (P<0.05). Intubation under first attempt was significantly higher in group A than group B. Haemo-dynamic parameters were also comparable. No major side effects/complications were observed.  Conclusion: We concluded that, both blind nasal and fibre optic tracheal intubation are of gold standard in patients with no or reduced mouth opening. However fibre optic nasal intubation requires less time and less number of attempts for intubation with minimal haemodynamic changes and have low incidences of complications.