Anesthesia, Intubation; Difficult or Failed, Cricoid Pressure, Pulmonary Aspiration During Anesthetic Induction
Conditions
Keywords
Paratracheal pressure, Glottic view, Cricoid pressure, Pentax
Brief summary
Recently, left paratracheal pressure was introduced as an alternative method to prevent pulmonary aspiration instead of cricoid pressure. Criocoid pressure is known to worsen glottic visibility when using Pentax.However, the effects of left paratracheal pressure on glottic view when using Pentax are not studied yet. In this study, the subjects are divided into two groups (group I: left paratracheal pressure applied before intubation, group II: conventional cricoid pressure applied before intubation). Investigators will assess the glottic view during intubation using Pentax.
Detailed description
Primary outcome \- Duration of intubation Secondary outcomes * POGO (percentage of glottic opening) score before and after application of each intervention * Glottic grade by Cormack Lehane * The success rate in first attempt * Intubation difficulty scale * Hemodynamics during intubation * Postoperative airway complications
Interventions
PROCEDUREParatracheal pressure
To apply paratracheal pressure, the thumb was placed over the left side of the trachea cephalad to the clavicle and medial to the sternocleidomastoid muscle.
PROCEDURECricoid pressure
To apply cricoid pressure, the crocoid cartilage was compressed with a single-handed three-finger maneuvre towards the vertebral bodies.
Sponsors
Ajou University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
The group assignments were sealed in opaque envelopes by a research assistant not involved in the study. The interventional process covers opaque clothes.
Intervention model description
Randomized double blinded clinical trial
Eligibility
Sex/Gender
ALL
Age
19 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Patients who are undergoing surgery under general anesthesia * American Society of Anesthesiologists Classification 1-2
Exclusion criteria
* Body mass index \> 35 kg/m2 * High risk of regurgitation (hiatus hernia, gastro-esophageal reflux disease, non-fasting status) * Criteria for difficult airway (limitation of mouth opening/neck extension, Mallampati class IV),
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to intubation | During anesthesia induction procedure | The duration from when Pentax pass the tooth to confirm the successful intubation using capnography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cormack-Lehane grade | During anesthesia induction procedure | The grade of glottic opening by intubation device (1= Full view of glottis, easy; 4=Neither glottis nor epiglottis seen, difficult) |
| Intubation difficulty scale (IDS) | During anesthesia induction procedure | The intubation difficulty scale by the sum of seven variables (N1-N7). N1= the number of additional intubation attempts, N2= the number of additional operators, N3= the number of alternative intubation techniques used, N4= the laryngoscopic view, as defined by Cormack and Lehane, N5= the lifting force applied during laryngoscopy, N6= to the necessity to apply external laryngeal pressure to optimize glottic exposure, N7= vocal cord mobility. The IDS score is the sum of N1 through N7. The total IDS score ranges from zero (easy) to infinity (difficult). |
| Intubation difficulty by NRS score | During anesthesia induction procedure | Intubation difficulty by NRS score (0=easy, 10=the most difficult) |
| The percentage of glottic opening (POGO) score | During anesthesia induction procedure | The percentage of glottic opening (POGO), linear span from the anterior commissure to the interarytenoid notch, 0-100% |
| Hemodynamic changes | During anesthesia induction procedure | Blood pressure (mmHg) at 4 time points: Baseline, 1 minute after injection of anesthetic drugs, immediately before intubation, and 1 minute after intubation |
| Postoperative complications | An average of 1 hours after extubation | Postoperative complications including sore throat, hoarseness/dysphonia, or pharyngeal pain |
| Success rate in first attempt | During anesthesia induction procedure | Successful intubation in a first attempt |
Countries
South Korea
Outcome results
None listed