Airway Management
Conditions
Keywords
Retromolar Intubation
Brief summary
Retromolar Intubation is a successful option for intubation in patients with an existing retromolar gap in the case that the conventional method fails. Therefore the investigators want to test if the retromolar gap is essential for performing the retromolar intubation technique.
Detailed description
For successful endotracheal intubation an optimal visualisation of the vocal cords is essential. A study comparing retromolar and conventional laryngoscopy showed in patients with an existing retromolar gap, that the retromolar technique is superior for endotracheal intubation especially in patients with a failed 'conventional' intubation attempt. The aim of the following study is to test if a retromolar gap at the right mandible is necessary for the successful performance of the retromolar laryngoscopy technique. Therefore, 20 patients with and 20 patients without a retromolar gap will be investigated. The anesthesiologist will visually determine the view of the vocal cords and score it according to Cormack & Lehane. For an improved view a backward, upward, right-ward pressure (BURP) will be performed, if needed, and scored again. Finally, endotracheal intubation will be performed by the 'conventional' intubation method. If, however, intubation is not possible, then the retromolar technique will be used. In the case that both methods fail, then any (other) intubation method will (can) be used.
Interventions
PROCEDURERetromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane
To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack & Lehane . This score will be assessed at least 2 minutes after muscle relaxation: 1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later): 2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again. Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used.
Sponsors
Medical University of Vienna
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* BMI \< 35kg/m2 * Elective surgery * Absence of at least one molar of the right mandible in arm I (20 patients)
Exclusion criteria
* Emergency patients * Prevalence of reflux disease * Toothless patients * Diaphragmatic hernia * Patient is not sober * Ventilation problems during induction of anaesthesia * Patient with a tracheostomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cormack & Lehane score (without a backward, upward, rightwards pressure maneuver) | At least 2 minutes after muscle relaxation | After ensuring sufficient bag-mask ventilation, the scoring of the vocal cords according to Cormack & Lehane will be performed at least 2 minutes after administration of the muscle relaxant rocuronium without a backward, upward, rightwards pressure maneuver (=BURB) |
| Cormack & Lehane score (with a backward, upward, rightwards pressure maneuver) | Approximately 5-10 seconds after the collection of the Outcome Measure 1 | If the Outcome Measure 1 does not reveal a 100% visualization of the vocal cords, a backward, upward, rightwards pressure maneuver (BURP) maneuver will be applied and scored again according to Cormack & Lehane . Usually each of the two scoring procedures lasts approximately 5-10 seconds. |
Countries
Austria
Outcome results
None listed