Difficult Airway
Conditions
Keywords
ultrasound, Difficult airways, Bougie
Brief summary
Difficult airway management remains one of the biggest challenges in anesthesia practice. The Gum elastic bougie, an intubation tool, is frequently used to facilitate intubation in difficult situations. Recently, ultrasound-guided airway management has been used as a potential method to improve the intubation process. This study aims to compare the efficacy of ultrasound-guided bougie insertion with the conventional method regarding the duration of endotracheal tube (ETT) insertion and the number of attempts required in a difficult intubation population. The goal of this clinical trial is to learn if using ultrasound during bougie insertion in difficult airway patients will improve the success rate and reduce the time of insertion. The main questions it aims to answer are: Does using ultrasound reduce the number of insertion attempts? Does using ultrasound reduce the duration of bougie insertion? Researchers will compare the ultrasound-guided technique to the conventional bougie insertion method. They will also assess both groups' hemodynamic parameters during and after the procedure and the success rate from the first trial.
Interventions
PROCEDUREultrasound guided bougie insertion
The anesthesiologist will use a high-frequency linear ultrasound probe at the level of the suprasternal notch to identify the tracheal rings. The probe will then be moved cephalad and placed over the cricothyroid membrane to visualize the vocal folds in the transverse view with the patient in the supine position. Using a C-mac laryngoscope, the intubator will assess the difficulty of visualization using the Cormack Lehan score; if the score is three or more, the bougie will be gently inserted with the curved tip anteriorly into the trachea and assess the real-time visualization of the bougie on the ultrasound screen as a linear echogenic structure moving through the hypoechoic lumen of the trachea then the tube will railed on the bougie and connected to the capnograph for endotracheal positioning confirmation when the square waveform will be maintained for five breaths.
PROCEDUREConventional methods for bougie insertion
The anesthesiologist will perform the bougie insertion using a C-mac laryngoscope, and he will assess the difficulty of visualization using the Cormack Lehan score; if the score is three or more, the bougie will be gently inserted with the curved tip anteriorly into the trachea while feeling the tracheal clicks as a sign of correct its placement, the intubator will advance it gently till feel resistance then withdraw 2-3 centimeters. If the depth of the bougie reaches 30 centimeters from the angle of the mouth without feeling the resistance, the bougie will be removed and reinserted. Then, the tube will be railed on the bougie and connected to the capnograph for endotracheal positioning confirmation when the square waveform is maintained for five breaths.
Sponsors
Mohammed Gaber Saad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
15 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 15 -75 years. * Elective surgical operation. * ASA (American Society of Anesthesiologists) physical status I-III. * Predicted difficult airway.
Exclusion criteria
* Emergency intubations. * Patients with contraindications to the use of bougie. * Patients with a known allergy to local anesthetics or ultrasound gel. * Pregnancy. * Craniofacial anomaly * Patients with obstructive sleep apnea * BMI \> 35. * Patient with gastroesophageal reflux disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of bougie insertion. | during the insertion of bougie | the time in seconds from the start of the bougie insertion to successful ETT placement |
| Number of attempts required for successful bougie insertion | during the insertion of bougie | As each separate insertion of the bougie: if the bougie cannot visualized by the ultrasound in (group A) OR if the depth of the bougie reaches 30 centimeters depth from the angle of the mouth without feeling the resistance in (group B), the bougie will be withdrawn and reinserted again. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Systolic and daistolic blood pressure changes during intubation | T1: 5 minutes before induction of anesthesia. T2: 5 minutes after tube positioning confirmation. T3:15 minutes after tube positioning confirmation | The systolic blood pressure in mmHg at T1, T2 and T3. The diastolic blood pressure in mmHg at T1, T2 and T3 |
| Success rate of the first attempt | during the insertion of bougie | Count the cases in which the insertion of bougie was confirmed from the first insertion trial. |
| Hemodynamic changes during intubation | T1: 5 minutes before induction of anesthesia. T2: 5 minutes after tube positioning confirmation. T3:15 minutes after tube positioning confirmation | The systolic blood pressure in mmHg at T1, T2 and T3. The diastolic blood pressure in mmHg at T1, T2 and T3 Heart rate per minute at T1, T2 and T3 |
| Heart rate during the procedure | Pulse rate per minute T1: 5 minutes before induction of anesthesia. T2: 5 minutes after tube positioning confirmation. T3:15 minutes after tube positioning confirmation | The pulse rate per minute will be observed and documented at T1, T2 and T3 |
Countries
Egypt
Outcome results
None listed