Nasal Intubation
Conditions
Brief summary
Magill forceps is used to maneuver the endotracheal tube ETT in the posterior oropharynx and place its tip into the laryngeal inlet. While the Magill forceps are useful in guiding the nasotracheal tube past the vocal cords, care must be taken to avoid excessive maneuvering in order to minimize the risk of local trauma and rupture of the nasotracheal tube balloon. Cuff inflation-deflation method can reduce the apnea time in the pediatric patients, a population with known physiological limitations in respiratory reserve. This, in turn, could point to a reduction in the complications (as desaturation and cardiac arrhythmia) that associated with the prolonged-time procedure.
Detailed description
the investigator will compare the cuff inflation-deflation method versus the conventional method of nasal intubation in pediatric patients for the need of using Magill forceps 90 pediatric patients between the ages of 3 and 12 years with the American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective surgery (dental and maxillofacial) will be enrolled in a prospectively randomized observer-blinded clinical trial. Patients, who have coagulopathies, have upper airway abnormalities, at risk for aspiration or by reasons of parent's refusal will be excluded from the study. Airway management is subdivided into phases: * Phase 1: Passage of the endotracheal tube through the nose into the pharynx * Phase 2: Video-laryngoscope-guided passage of the endotracheal tube through the pharynx into the trachea. Phase 2 can be performed with the tracheal tube cuff inflation-deflation method vs. non-cuff inflation method. A Magill forceps can be used to guide the endotracheal tube pass through the pharynx and glottis into the trachea if required. Tracheal tube cuff inflation-deflation method: Tracheal tube cuff is inflated with a variable amount of air (volume of air is depending on the level of the larynx). Once the tip of endotracheal tube at the laryngeal inlet, the cuff of the endotracheal tube is deflated and advanced into the trachea Patients included in the study will be assigned into two groups for the second phase of airway management: Group A (n = 45) in whom nasal intubation will be performed using the cuff inflation-deflation method; and Group B (n = 45), in whom the nasal intubation will be performed using non-inflation method.
Interventions
PROCEDUREcuff deflation-inflation -deflation method
Nasotracheal intubation placed with video-laryngoscopy assistance, via the tracheal tube cuff inflation-deflation method with or without the aid of Magill forceps
Sponsors
Suez Canal University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
3 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status I-II, * Scheduled for elective surgery (dental and maxillofacial) in need for nasal intubation.
Exclusion criteria
* Patients, who have coagulopathies, * Have upper airway abnormalities, * At risk for aspiration or by reasons of * Parent's refusal will be excluded from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| to test whether the inflation-deflation method (pre-cuff inflation) would decrease the need for Magill forceps in video laryngoscopy assisted nasal intubation in pediatric patients compared with the conventional non-cuff inflation approach. T | during nasal intubation : 60 seconds | The percentage of patients who did not require Magill forceps for nasal intubation success was recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The number of attempts required for successful nasal intubation. | 120 seconds | number of trials, how many numbers of attempts the investigator take for successful nasal intubation |
| Amount of injected air for cuff inflation | 15 seconds | Amount of injected air in ml, how many air injected in the cuff balloon to make the tip of endotracheal tube advanced into the trachea |
| The time period for the second phase nasal intubation | 60 seconds | The time in seconds for the second phase nasal intubation |
| Evaluation of oxygenation state during nasal intubation | preoperative and intraoperative | rate of oxygen drop during the procedure |
| evaluate the anesthetists' experience of using the inflation-deflation method for nasal intubation. | 20 minutes after complete recovery of patients | score 1 to 5 A five-point Likert scales for: How likely is it that anesthetist would recommend the same used inflation-deflation method to practice a colleague in the future (not at all/ slightly/ moderately/ very/ extremely: where 1 is not at all, 3 is moderate,5 is extremely |
| Assessment of side effects of using Magill forceps during nasal intubation | Intraoperative and in the first 48 postoperative hours] | A 4-point scale: 1- No epistaxis; 2-Mild epistaxis (blood on the tracheal tube only); 3- Moderate epistaxis (blood pooling in the pharynx); 4- Severe epistaxis (blood in the pharynx sufficient to impede intubation) |
Countries
Egypt
Contacts
Primary ContactTarek F. Tammam, Professor
Backup ContactGhada A. Kamhawy, Lecturer
Outcome results
None listed