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 Airway Scope and GlideScope laryngoscopes for tracheal intubation in patients with cervical spine immobilisation using MILNS. The GlideScope laryngoscope, is a modification of the standard Macintosh blade, with a high-resolution camera and with a light source for illumination embedded within the blade. Endotracheal intubation is performed based on an image on a screen. Its use is well described in the airway management of patients with immobilised cervical spines. The Airway Scope, in contrast, is a novel intubation device. It is a video laryngoscope with a reusable handle and desposible blade. 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 intend to 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 Airway Scope or the GlideScope. All intubations will be performed by one anaesthetist 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 Airway Scope. The process involves placing a breathing tube in the trachea 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 patients mouth. The Airway Scope is a novel video laryngoscope with a number of design features that suggest its utility in the setting of cervical spine immobilisation.
Sponsors
Michael Edwards
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
Patients presenting for elective surgery requiring tracheal intubation Americian Society Anesthesiologists (ASA) physical status 1-3
Exclusion criteria
Age >18, Mental impairment, Clinical signs of difficult airway, History of difficult airway
Outcome results
None listed