Abrasion of Soft Palate, Intubation Complication
Conditions
Keywords
Videolaryngoscopy, Palatopharyngeal distance, Trauma
Brief summary
In this randomised crossover trial we measure the space between the right side of the laryngoscope blade and the right palatopharyngeal wall in a cohort of ASA I-III patients with a normal mouth opening. We compare the remaining spaces for seven different videolaryngoscopes and compare these to a classic Macintosh laryngoscope.
Detailed description
Intubation using indirect videolaryngoscopy has many advantages over classic direct laryngoscopy using the Macintosh laryngoscope. There are many different videolaryngoscopes available, and the blade differs largely between videolaryngoscopes. Different size and angles of blades may have an impact on the space available for insertion of the endotracheal tube. The space between the blade and the palatopharyngeal wall may be reduced significantly, so that there is less room in the mouth to insert an endotracheal tube. Positioning and manoeuvring of the endotracheal tube may consequently be more difficult and may traumatize the pharynx as was described in a few case reports, especially when an endotracheal tube with a rigid stylet inserted was used.
Interventions
DEVICEC-MAC ® videolaryngoscope
C-MAC ® videolaryngoscope
DEVICECoopdech® videolaryngoscope
Coopdech® videolaryngoscope
DEVICEMcGrath® Series 5 videolaryngoscope
McGrath® Series 5 videolaryngoscope
DEVICEGlidescope® Cobalt videolaryngoscope
Glidescope® Cobalt videolaryngoscope
DEVICEKing Vision® videolaryngoscope
King Vision® videolaryngoscope
DEVICEVenner® videolaryngoscope
Venner® videolaryngoscope
DEVICEMcGrath® MAC
McGrath® MAC (Aircraft Medical, Edinburgh, UK)
Sponsors
Catharina Ziekenhuis Eindhoven
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Informed patient consent * ASA I - III * Age \> 18 years * Elective surgery, other than head and/or neck surgery * Pre-operative Mallampati I - III * BMI \< 35 kg/m2 * Fasted (≥6 hours)
Exclusion criteria
* No informed patient consent * ASA ≥ IV * Age \< 18 year * Emergency surgery, surgery of head and/of neck * Locoregional anaesthesia * Pre-operative Mallampati IV * BMI \> 35 kg/m2 * Fasted \< 6 hours * Pre-operative expected difficult airway (restrict neck movement, thyromental distance \< 65mm, retrognathia) * Bad, fragile dentition * Dental crowns and/or fixed partial denture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Palatopharyngeal distance | Participants will be followed during induction of anesthesia, an expected average of 10 min | Two laryngoscopes (one classic direct laryngoscope and one indirect videolaryngoscope) will subsequently be inserted into the patient's mouth at random order. With each laryngoscope the horizontal distance between the laryngoscope blade and mid-palatopharyngeal fold will be measured using an mm ruler. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in palatopharyngeal distance between videolaryngoscopes | Participants will be followed during induction of anesthesia, an expected average of 10 min | Comparing the difference in remaining palatopharyngeal space between the different videolaryngoscopes. |
| Cormack-Lehane score | Participants will be followed during induction of anesthesia, an expected average of 10 min | Registering difficulty of intubation (Cormack-Lehane score) |
| Successful intubation | Participants will be followed during induction of anesthesia, an expected average of 10 min | Registering the number of successful intubations. |
| Use of rigid stylet | Participants will be followed during induction of anesthesia, an expected average of 10 min | Use of rigid stylet during intubation |
| Difference in palatopharyngeal distance between videolaryngoscope and classic Macintosh laryngoscope | Participants will be followed during induction of anesthesia, an expected average of 10 min | Investigating how this space differs from the space that remains on the right side of the blade of the classic Macintosh laryngoscope and the palatopharyngeal wall in the same cohort of patients. |
| Time until picking up endotracheal tube | Participants will be followed during induction of anesthesia, an expected average of 10 min | Time until picking up endotracheal tube |
| Epiglottic down-folding | Participants will be followed during induction of anesthesia, an expected average of 10 min | Occurrence of epiglottic down-folding |
| Complications | Participants will be followed during induction of anesthesia, an expected average of 10 min | Any complication that occurs during intubation will be registered. |
| Number of attempts | Participants will be followed during induction of anesthesia, an expected average of 10 min | Number of intubation attempts |
Countries
Netherlands
Outcome results
None listed