None listed
Conditions
Brief summary
1. Introduction There are few reports of using videolaryngoscopy to manage the airway for C-Section. We found no study evaluating the use of the KingVision videolaryngoscope for airway management in obstetric anaesthesia. The main goal of this study is to compare the KingVision videolaryngoscope with CMac videolaryngoscope and directoscopy with respect to time to successful intubation. The secondary outcomes are the quality of the laryngoscopic view, comparative ease of blade and tracheal tube insertion, the number of attempts at intubation, the rate of successful intubation, the use of optimization manoeuvres and the need for airway adjuncts. 2. Methods After the Institutional Review Board Ethical Committee approval and the patients’ informed consent for general anaesthesia and endotracheal intubation, 180 parturients of ASA physical status 1-3, scheduled for either elective or emergency C-section will be included in the study. Patients with the ASA physical status >3 or the predicted difficult airway requiring awake intubation will be excluded. Patients will be assigned to three groups using a computer-generated random number table. After recruitment, a sealed envelope with the group allocation will be opened by the enrolling investigator. All intubations will be performed by experienced anaesthesiologists who have previously done more than 30 intubations with the tested devices. Patients will be preoperatively evaluated to ascertain predictive indices for difficult intubation. GA will be commenced with a classical rapid sequence induction using a combination of fentanyl 1microgram/kg, propofol 2mg/kg and succinylcholine 1.5mg/kg or rocuronium 1 mg/kg. After fasciculation wearing off, the laryngoscopy will be carried out using one of the VLs or the classical metal Macintosh blade #3 or 4.
Interventions
After rapid sequence induction using a combination of propofol 2mg/kg i.v., esmeron 1 mg/kg i.v. and Fentanyl 1 mcg/kg i.v. and anaesthetist used one of three intubation devices.
Direct laryngoscopy using a curved Macintosh blade is still the standard technique for tracheal intubation during C-section but the video laryngoscopes can provide an indirect view of the larynx and have been used to manage the difficult airway in the operating room.
The King Vision Video laryngoscope (KVL) (King Syste
After rapid sequence induction using a combination of propofol 2mg/kg i.v., esmeron 1 mg/kg i.v. and Fentanyl 1 mcg/kg i.v. and anaesthetist used one of three intubation devices. Direct laryngoscopy using a curved Macintosh blade is still the standard technique for tracheal intubation during C-section but the video laryngoscopes can provide an indirect view of the larynx and have been used to manage the difficult airway in the operating room. The King Vision Video laryngoscope (KVL) (King Systems, Indianapolis, Indiana) is a new indirect two-piece design laryngoscope consisting of a reusable monitor attached to disposable blades. All blades are Macintosh #3 size and compared to a normal Macintosh #3 bladed laryngoscope appear wider and shorter. The blade is inserted into the mouth in the middle, over the centre of the tongue with a single circular movement, while its back surface is maintained against the palate and palatopharyngeal curve. Once the view of glottis is optimized, the tube is passed through the vocal cord into the trachea. We used KVL with a guiding channel. The guiding channel is positioned on the right side of the blade and acts as a conduit holding and directing the tracheal tube through the glottic opening when the vocal cords are visualized. The C-MAC Video laryngoscope has the Macintosh # 3 or 4 blades incorporating a high-power light-emitting diode located in their distal third and extending the viewing angle from the standard 15 degrees to 80 degrees. The VL consists of two parts, a laryngoscope and a monitor, connected via a single cable. A 2-mm digital camera is sited within the shorter laryngoscope handle and a magnified image displayed on a screen. The C-MAC displaces soft tissue in a similar fashion to a classic Macintosh laryngoscope, affording room for tracheal tube insertion and consequently less need for intubating adjuncts.
Sponsors
University medical center Ljubljana
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
Parturients of ASA physical status 1-3, scheduled for either elective or emergency C-section
Exclusion criteria
Patients with the ASA physical status >3 or the predicted difficult airway requiring awake intubation will be excluded.
Outcome results
None listed