Intubation; Difficult
Conditions
Keywords
Flexible fiberscope
Brief summary
This study is designed to identify patients' features predictive of difficult endotracheal intubation using a flexible fiberscope.
Detailed description
Endotracheal intubation is an important act in the practice of anesthesiology. Direct laryngoscopy is the most commonly used technique to accomplish this task. Airway characteristics predicting difficult intubation with direct laryngoscopy are well defined. Physical findings, such as Mallampati classification or measurements of the thyromental distance, mouth opening, and neck extension have been validated to help anticipate difficult situations with the direct laryngoscope. When direct laryngoscopy is difficult, early conversion to an alternative technique reduces the risk of airway compromise and associated morbidity. Many alternative intubation devices are now available, and part of the anesthesiologist's task is to select the alternative approach best suited to each patient's specific features. Despite its use for both elective and unexpectedly difficult intubation, predictive criteria for successful airway management with the flexible fiberscope have not been developed. The purpose of this study is to identify patient morphometric or morphological characteristics, if any, that could predict difficult intubation when using the flexible fiberscope for perioperative tracheal intubation in an elective surgical population.
Interventions
DEVICEFlexible fiberscope
* Characteristics of patients will be assessed before induction of general anesthesia * Glottic visualization will be evaluated by direct laryngoscopy. * The endotracheal tube will be loaded onto the scope after silicon spray lubrication * Intubation will be performed with the flexible fiberscope with the patient in supine position with head and neck in neutral position * With the tip of the fiberscope in satisfactory position, the endotracheal tube will be advanced into the trachea. The scope will then be removed. * Accurate positioning of the endotracheal tube will be confirmed by capnography and lung auscultation.
Sponsors
Centre hospitalier de l'Université de Montréal (CHUM)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 and older * Patients undergoing elective surgery under general anesthesia, requiring endotracheal intubation
Exclusion criteria
* Induction planned without neuromuscular blocking agents * Need for a rapid sequence induction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphologic and morphometric predictors of difficult intubation with the flexible fiberscope. | Patients will be followed from induction of anesthesia until the end of intubation, an average of 10 minutes | This study will correlate patients' morphometric and morphologic characteristics with the number of attempts and time needed for intubation using a flexible fiberscope. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to successful intubation | Patients will be followed from induction of anesthesia until the end of intubation, an average of 10 minutes | — |
| Number of attempts to successful intubation | Patients will be followed from induction of anesthesia until the end of intubation, an average of 10 minutes | — |
| Score on the Intubation Difficulty Scale | Patients will be followed from induction of anesthesia until the end of intubation, an average of 10 minutes | To calculate the Intubation Difficulty Scale the following variables will be collected: number of attempts, number of operators, necessity to use an alternative intubation technique, glottic visualization and effort needed to obtain optimal view of the glottis, necessity of external laryngeal pressure and vocal cords position during intubation. |
Countries
Canada
Outcome results
None listed