None listed
Conditions
Brief summary
Failure to immobilise the neck during tracheal intubation in patients with cervical spine injuries (CSI) can result in a devastating neurologic outcome. One method to immobilise the neck during laryngoscopy and tracheal intubation is manual in-line neck stabilisation (MILNS). With MILNS, however, it is often more difficult to visualise the larynx using conventional laryngoscopy. Consequently, the application of MILNS may result in failure to secure the airway, which may result in substantial morbidity or even mortality. These issues highlight the need to develop alternative approaches to securing the airway in patients with CSI. The purpose of the proposed study is to compare the performance of the Airtraq and McCoy laryngoscopes for tracheal intubation in patients with cervical spine immobilisation using MILNS. The McCoy laryngoscope, introduced into clinical practice in 1993, is a modification of the standard Macintosh blade. It is a familiar anaesthetic tool with an established place in the airway management of patients with immobilised cervical spines. The Airtraq, in contrast, is a novel intubation device. It is a single-use optical laryngoscope with a number of design features that suggest its utility in the setting of cervical spine immobilisation. A limited amount of research to date has generally supported this proposition. We hypothesise that, in comparison with the McCoy, the Airtraq laryngoscope will be associated with faster intubations of reduced complexity. We intend to test our hypothesis by conducting a randomised, single-blind, controlled clinical trial. All patients will receive a standardised general anaesthetic with routine non-invasive monitoring. The neck will be immobilised using MILNS applied by an experienced assistant. Participants will be randomly assigned to tracheal intubation with either the Airtraq or the McCoy laryngoscope. All intubations will be performed by one of two consultant anaesthetists experienced in the use of both laryngoscopes. The primary outcome measures will be intubation time and the Intubation Difficulty Scale score. Any complications or difficulties will be recorded.
Interventions
A single tracheal intubation using the Airtraq laryngoscope. The process of intubation involves placing a breathing tube in the 'windpipe' and it occurs after the patient is anaesthetised. The intubation procedure takes less than 2 minutes to complete. Intubation is usually aided by a device called a laryngoscope, which is placed in the patient's mouth. The Airtraq is a novel, single-use optical laryngoscope with a number of design features that suggest its utility in the setting of cervical spi
A single tracheal intubation using the Airtraq laryngoscope. The process of intubation involves placing a breathing tube in the 'windpipe' and it occurs after the patient is anaesthetised. The intubation procedure takes less than 2 minutes to complete. Intubation is usually aided by a device called a laryngoscope, which is placed in the patient's mouth. The Airtraq is a novel, single-use optical laryngoscope with a number of design features that suggest its utility in the setting of cervical spine immobilisation.
Sponsors
Dr Michael Bishop
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Adult patients (American Society of Anesthesiologists Physical Status 1 & 2) presenting for elective surgery requiring tracheal intubation
Exclusion criteria
Patients with a past history of difficult tracheal intubation, or with clinical signs of potential difficulty with tracheal intubation
Outcome results
None listed