None listed
Conditions
Brief summary
Intubation is one of the most important skills that anaesthetists have. There are currently many different intubating devices available. Anaesthetists have to develop and maintain skills with more than one type of device, so that when faced with difficult tracheal intubation, a safe alternative technique can be used without causing complications. Both the McGrath and the C-MAC videolaryngoscopes are relatively new intubating devices, which have a high-resolution camera and light source embedded at the distal end of the blade. They allow a view of the anterior glottis without the need for a direct line of sight. Both devices claim to provide a comparable or superior glottic view when compared with direct laryngoscopy using the standard curved Macintosh blade. However, the design of the shape of the blades between the two videolarygoscopes are very different. Currently, there are no studies comparing the use of these two devices in patients with potential difficult airways, which are usually the most useful situations. The aim of this prospective randomized controlled trial is to compare the effectiveness of using these two devices in performing endotracheal intubation in adult patients with predicted difficult airways. The research is designed to be conducted in 130 adult patients with Mallampatti 3 or 4 (one of the predictors of difficult airways) and ASA 1-3 having oro-tracheal intubation for elective surgery . After informed consent, the patients will be randomized to having either the McGrath or C-MAC videolarygngoscopes for the intubation. The primary outcome is the timing of intubation. Secondary outcomes include the glottic view, ease of intubation, number of attempts required, haemodynamic changes and also any associated complications.
Interventions
Patients will be anaesthetized in an area with appropriate monitoring, resuscitation equipment and assistance in accordance with the Australian and New Zealand College of the Anaesthetists’ guidelines. After pre-oxygenation with 100% oxygen to reach the end-tidal oxygen (O2) = 70%, patients will be given induction agents and neuromuscular agent of choice at the discretion of the anaesthetist involved with the patient’s overall care. Patients will be placed in the “sniffing” position with the hea
Patients will be anaesthetized in an area with appropriate monitoring, resuscitation equipment and assistance in accordance with the Australian and New Zealand College of the Anaesthetists’ guidelines. After pre-oxygenation with 100% oxygen to reach the end-tidal oxygen (O2) = 70%, patients will be given induction agents and neuromuscular agent of choice at the discretion of the anaesthetist involved with the patient’s overall care. Patients will be placed in the “sniffing” position with the head on a pillow and ventilated via a face-mask with 100% oxygen until complete paralysis is achieved. Patients will then be intubated with either the Miller straight blade laryngoscope or the Video Laryngoscope, according to the study allocation. The intubation will be performed by an experienced anaesthetist (> 10 years’ experience) who is familiar with the use of both devices (> 10 uses on each device) prior to the study. The McGrath Videolaryngoscope blade will be inserted along the midline of the tongue, with the introduction of a styleted endotracheal tube angulated according to the curve of the Video Laryngoscope blade, as suggested by the case series studies. If more than one attempt of intubation is required, the patient will receive bag-and-mask ventilation between attempts and various manoeuvres can be introduced, such as, external laryngeal pressure, readjustment of stylet and bougie assistance. Failed intubation is defined as failure after three attempts. An alternative airway management plan can then be resorted to at the discretion of the anaesthetist. This is a one-off treatment.
Sponsors
Royal Melbourne Hospital
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
No
Inclusion criteria
Mallampati III or IV Undergoing elective surgery at Royal Melbourne Hospital Requiring oro-tracheal intubation American Society of Anesthesiology (ASA) Grade I, II or III Over 18 years of age
Exclusion criteria
Non English speaking or reading ASA Grade IV or V Presence of any other predictors of difficult intubation
Outcome results
None listed