Bed up Head Elevated Intubation Position
Conditions
Keywords
Bed up head elevated position, Glidescope assisted tracheal intubation, Laryngeal exposure, Time to intubation
Brief summary
Positioning during the process of tracheal intubation is critical, as optimal positioning can greatly facilitate successful intubation. Many complications can occur as a result of failed intubation, ranging from airway injury, lack of oxygen, with even deaths. Today, the most popular positioning of patients for intubation is in the sniffing position. There is however evidence to support that intubation in the bed-up-head-elevated position may be better. In today's technological age, video assisted laryngoscopy (Laryngoscopy is the process of visualizing the vocal cords prior to intubation), a new method where the anaesthetist intubates a patient via aid of an image guided view of the airway, is increasingly popular due to its reliability and superiority to normal intubation. However, it is not widely available, and may suffer from technical breakdowns. The Glidescope is one example of a video laryngoscope, and has been widely researched in the medical literature. In this study, the investigators wish to investigate whether intubation in the bed-up-head-elevated position will be as good as, if not better than Glidescope assisted tracheal intubation, in patients undergoing elective surgery and planned for general anaesthesia.
Interventions
PROCEDURETracheal intubation
Intubation of the trachea with endotracheal tube
DEVICEGlidescope assisted tracheal intubation
With the use of the Glidescope video laryngoscope, the trachea will be intubated with the endotracheal tube
DEVICEBed up head elevated tracheal intubation
Use of the Macintosh laryngoscope blade size 3
Sponsors
University of Malaya
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Masking description
Investigator is blinded to the initial laryngeal exposure during the sniffing position, but is unblinded during assessment of laryngeal exposure in either the bed up head elevated position or glidescope assisted tracheal intubation
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
1. Patients undergoing elective surgeries under general anaesthesia 2. Patients aged from 18 years old to 75 years old 3. Patients who are able to give informed consent
Exclusion criteria
1. Patients with airway obstruction 2. Patients with contraindications to neck extension 3. Patients with small mouth opening (\<3 cm) 4. BMI \> 35 kg/m3 5. Patients with ischemic heart disease, cerebrovascular disease and respiratory diseases 6. Patients in whom rapid sequence induction is indicated
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Laryngeal exposure | Through study completion, period of 1 year | Measured by Percentage of Glottic Opening (POGO) score. A 100% POGO score refers to visualisation of the entire glottic opening from the anterior commissure of the vocal cords to the interarytenoid notch. A POGO score of 0% refers to no visualisation of laryngeal structures. A 100% score is optimal. |
| Time required for intubation | Through study completion, period of 1 year | Measured from the time the tip of the laryngoscope passes through the incisors to the time of the first recorded wave of capnography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of intubation attempts | Through study completion, period of 1 year | — |
| Effort during laryngoscopy | Through study completion, period of 1 year | Assessed based on a visual analogue scale, with 10 being the strongest effort, and 1 being the least effort required. |
| Complications arising from intubation | Through study completion, period of 1 year | Incidence of hypoxia, hypotension, or esophageal intubation. Yes/no categories. |
| Airway trauma | Through study completion, period of 1 year | Whether injury occurs to the lips, tongue, teeth, and other structures in the oropharyngeal area. Yes/no categories. |
Countries
Malaysia
Outcome results
None listed