Comparison of Intubating Conditions between Cuff Inflation and Magill’s Forceps Techniques for Nasotracheal Intubation in Adults under Direct Laryngoscopy: A Randomised Clinical Trial

Introduction: Nasotracheal Intubation (NTI) is frequently required for oral and maxillofacial surgeries, but optimal techniques for guiding the Endotracheal Tube (ETT) towards the glottis remain debated. While Magill’s forceps have traditionally been used to guide the ETT towards the glottis during NTI, the cuff inflation technique has emerged as a potentially safer alternative. Aim: To compare the intubating conditions between cuff inflation and Magill’s’s forceps techniques for NTI in adults under direct laryngoscopy. Materials and Methods: The present randomised clinical single blinded study was conducted at Dhiraj Hospital Piparia, Vadodara, Gujarat, India, from 13th July 2024 to 1st may 2025 on 80 American Society of Anaesthesiologists (ASA) I-II patients aged 18-60 years undergoing elective surgeries requiring NTI. Patients were randomly allocated into two groups using computer generated sequence: Group C (n=40) underwent NTI using the cuff inflation technique, while group M (n=40) underwent NTI using Magill’s forceps. The primary outcomes included the time required for successful intubation, number of attempts, and secondary outcomes included haemodynamic response, external laryngeal manoeuvre requirement, and complications. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p<0.05. Results: A total of 80 patients were included in the study with 40 patients per group groups were demographically comparable. Total intubation time was significantly shorter in group C (40.38±3.95) compared to group M (51.84±4.78 seconds) (p<0.001). Group C showed higher first-attempt success rate (80.0% vs 75.0%, p=0.008). External laryngeal manoeuvre was required less frequently in group C 6 (15.0%) patients compared to group M 14 (35.0%) patients (p=0.037). The cuff inflation technique demonstrated attenuated haemodynamic response with significantly lower increases in Heart Rate (HR) and blood pressure at 1 and 3 minutes post intubation. Complications including nasal bleeding and ETT cuff damage were significantly lower in group C. Conclusion: The cuff inflation technique provides superior intubating conditions compared to the Magill’s’s forceps technique, with shorter intubation time and fewer complications. It may be considered a safer and more efficient alternative for NTI under direct laryngoscopy in adults.