- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03810937
Optimal Head and Neck Position for Videolaryngoscopy
January 23, 2019 updated by: Munir Bamadhaj, King Fahad Specialist Hospital Dammam
Optimal Head and Neck Position for Videolaryngoscopy Intubation
The introduction of videolaryngoscopy constituted a revolution in airway management since it could provide better laryngeal exposure (indirect) in situations of difficult or impossible visualization by direct laryngoscopy.
The use of Videolaryngoscopes, however, does not always guarantee adequate exposure or end up always in successful tracheal intubation.
Failed tracheal intubation with videolaryngoscopy has been reported.
We hypothesized that may be the failure was due to omitting some preparatory steps, including optimal head positioning, leading to a less than expected exposure and/or difficult or impossible intubation.
There are no recommendations currently from the scientific organizations regarding the optimal head position when using a GlideScope and it is unknown currently whether head position can affect visualization or tracheal intubation attempts when using this device.
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Detailed Description
- Multicentric,randomized, prospective and controlled study.
- After Institutional Review Board approval, signed written informed consents will be obtained from 165 adult patients with American Society of Anesthesiologists physical status 1-3 who are scheduled for elective surgery requiring endotracheal intubation.
- The following parameters will assessed and documented during the preoperative airway evaluation: BMI, mouth opening, thyromental distance, range of neck movement, and modified Mallampati classification. An 8cm non-compressible pillow.
- Patients will be randomized following coin toss into two groups depending on intubation position; Group Sniffing position(S) for obverse side and group flat position(F) for reverse side
- After premedication, American Society of Anesthesiologists' standard monitors will be applied, and preoxygenation for 3 to 5 minutes will be performed. After anesthesia induction and complete muscle relaxation as evidenced by loss of all evoked adductor pollicis responses to train of four stimulation of the ulnar nerve:
- Group sniffing (S): investigator will start by performing first videolaryngoscopy to find best view in flat position then the anesthesiologist will remove the Glidescope and the patient will be positioned in sniffing position using the pillow and another videolaryngoscopy will be attempted in sniffing position to find best view in this position and the patient will be intubated in this position.
- Group flat (F): same procedure will be done but starting from sniffing position and the patient will be intubated in flat position.
- The laryngoscopist will be asked not to use external laryngeal manipulation and to use the same lifting force throughout the study period. If these maneuvers deemed necessary for tracheal intubation (no visualization of vocal cords from full inflation to full deflation or the reverse, the laryngoscopist will be asked grade the view before applying the maneuver then use the required maneuver and record which intervention was needed and utilized.
- The estimated time to review theses different head elevation degrees is around 45 seconds.
- After preoxygenation technique we have a margin of 6 to 8 minutes of apnea without significant desaturation. Investigator will exclude also patients with high risk of desaturation (obesity and initial low saturation).
- The indirect laryngoscopic views will be graded using the same grading method used for direct laryngoscopy i.e. modified Cormack and Lehane. POGO score (percent of glottis opening viewed) will be also used to subcategorize subjects whose views lie between grade 1 and 3 C&L.
Analysis of the recorded videolaryngoscopic attempts will be performed later by a blinded researcher who was not involved with airway management.
Study Type
Interventional
Enrollment (Anticipated)
170
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: MUNIR H BAMADHAJ, MD
- Phone Number: 3993 00966138442222
- Email: MUNIR.BAMDHAJ@KFSH.MED.SA
Study Contact Backup
- Name: ZAKI M ALZAHER, MD
- Phone Number: 3939 00966138442222
- Email: ZAKI.ALZAHIR@KFSH.MED.SA
Study Locations
-
-
Eastern Province
-
Dammam, Eastern Province, Saudi Arabia, 31444
- Recruiting
- King Fahad Specialist Hospital
-
Contact:
- AHED M ZAIDANE, MD
- Phone Number: 3993 +966138442222
- Email: AHED.ZEIDAN@KFSH.MED.SA
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years and older (Child, Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Adult patients with American Society of Anesthesiologists physical status 1-3 who are scheduled for elective surgery requiring endotracheal intubation.
Exclusion Criteria:
- history of difficult intubation, poor dentition, gastroesophageal reflux disease ,initial low oxygen saturation, severe/morbid obesity (body mass index [BMI] greater than 35 kg/m2),neck deformities, atlano-axial subluxation or at risk of aspiration.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Group sniffing (S)
intervention: Head position changes : we will start by performing first videolaryngoscopy to find best view in flat position then the anesthesiologist will remove the Glidescope and the patient will be positioned in sniffing position using the pillow and another videolaryngoscopy will be attempted in sniffing position to find best view in this position and the patient will be intubated in this position.
|
head positioning in sniffing or flat position
|
Active Comparator: Group Flat (F)
intervention: Head position changes same procedure will be done but starting from sniffing position and the patient will be intubated in flat position.
|
head positioning in sniffing or flat position
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
optimal head position during videolaryngoscopy intubation
Time Frame: intratracheal intubation procedure
|
the optimum head position during videolaryngoscopy intubation will be successful first pass tracheal intubation.
|
intratracheal intubation procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
best laryngeal exposure
Time Frame: intratracheal intubation procedure
|
the best laryngeal exposure (according to modified Cormack and Lehane classification) head position
|
intratracheal intubation procedure
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: MUNIR H BAMADHAJ, MD, King Fahad Specialist Hospital Dammam
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
August 1, 2018
Primary Completion (Anticipated)
February 1, 2019
Study Completion (Anticipated)
March 1, 2019
Study Registration Dates
First Submitted
January 18, 2019
First Submitted That Met QC Criteria
January 18, 2019
First Posted (Actual)
January 22, 2019
Study Record Updates
Last Update Posted (Actual)
January 25, 2019
Last Update Submitted That Met QC Criteria
January 23, 2019
Last Verified
January 1, 2019
More Information
Terms related to this study
Other Study ID Numbers
- ANS004
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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