Direct Versus Video Laryngoscopy in Patients With Acromegaly (ACRO-VL)
Determination of the Appropriate Intubation Method in Patients With Acromegaly: Comparison of Direct Laryngoscopy and Video Laryngoscopy
Acromegaly is associated with craniofacial skeletal changes and upper airway soft tissue hypertrophy, which may increase the risk of difficult laryngoscopy and tracheal intubation. This prospective observational study aims to evaluate airway and intubation characteristics in patients with acromegaly undergoing surgery under general anesthesia and to compare direct laryngoscopy and video laryngoscopy findings.
Adult patients with acromegaly and patients with nonfunctioning pituitary adenomas scheduled for surgery under general anesthesia will be prospectively enrolled between July 1, 2026, and August 31, 2026. Preoperative airway assessment parameters, hormonal data including growth hormone and insulin-like growth factor-1 levels, Mallampati score, modified Cormack-Lehane grade, intubation-related variables, and peri-intubation complications will be recorded.
調査の概要
状態
状態
詳細な説明
This prospective observational study will be conducted at Basaksehir Cam and Sakura City Hospital between July 1, 2026, and August 31, 2026. The study population will include adult patients with acromegaly and adult patients with nonfunctioning pituitary adenomas who are scheduled for elective surgery under general anesthesia requiring endotracheal intubation.
Eligible patients will undergo routine preoperative airway assessment. Recorded variables will include age, sex, height, body weight, body mass index, history of obstructive sleep apnea syndrome, comorbid diseases, previous operations, presence of hypopituitarism, preoperative growth hormone level, preoperative insulin-like growth factor-1 level, IGF-1 index, Mallampati score, and other airway-related clinical parameters.
During airway management, laryngoscopic findings obtained with direct laryngoscopy and video laryngoscopy will be recorded. The modified Cormack-Lehane classification will be used to assess glottic visualization. Intubation-related variables, including first-attempt success, time to successful intubation, number of intubation attempts, need for adjunct airway maneuvers or devices, oxygen desaturation, and airway trauma, will also be documented.
The primary objective of the study is to compare laryngoscopic findings and intubation characteristics in patients with acromegaly and to evaluate whether video laryngoscopy provides advantages over direct laryngoscopy in this patient group. The secondary objective is to identify clinical, hormonal, and airway-related predictors of difficult laryngoscopy or difficult intubation in patients with acromegaly.
研究の種類
研究の種類
入学 (推定)
入学
連絡先と場所
研究連絡先
研究連絡先
- 名前:Muzaffer Gencer, associate professor
- 電話番号:+90 212 909 60 00
- メール:dr.m.gencer07@gmail.com
参加基準
適格基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Age 18 years or older
- Diagnosis of acromegaly and scheduled for surgery after evaluation by the institutional pituitary diseases council
- Diagnosis of nonfunctioning pituitary adenoma and scheduled for surgery after evaluation by the institutional pituitary diseases council
- Requirement for general anesthesia with endotracheal intubation
- Ability and willingness to provide written informed consent
Exclusion Criteria:
- Age younger than 18 years
- Refusal to participate in the study
- Presence of extrapituitary malignancy
- Emergency surgery
- Previous tracheostomy or major laryngeal/tracheal surgery
- Severe limitation of mouth opening preventing standard laryngoscopic evaluation
- Cervical spine instability or severe restriction of neck extension
- Patients requiring awake fiberoptic intubation according to preoperative airway assessment
- Patients for whom participation is considered unsafe by the responsible anesthesiologist
研究計画
研究はどのように設計されていますか?
デザインの詳細
グループ/コホートの数
コホートと介入
グループ/コホートグループ/コホート |
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Acromegaly Group
Adult patients diagnosed with acromegaly who are scheduled for elective surgery under general anesthesia requiring endotracheal intubation.
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Nonfunctioning Pituitary Adenoma Group
Adult patients diagnosed with nonfunctioning pituitary adenoma who are scheduled for elective surgery under general anesthesia requiring endotracheal intubation.
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この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Modified Cormack-Lehane Grade With Direct and Video Laryngoscopy
時間枠:During tracheal intubation procedure
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The modified Cormack-Lehane grade obtained during direct laryngoscopy and video laryngoscopy will be recorded and compared to evaluate glottic visualization and the degree of laryngoscopic difficulty.
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During tracheal intubation procedure
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二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Mallampati Classification Score
時間枠:Preoperative airway assessment before induction of anesthesia
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The preoperative Mallampati Classification score will be recorded as part of the routine airway assessment and evaluated for its association with difficult laryngoscopy or difficult intubation.
The Mallampati Classification ranges from Class I to Class IV, with a minimum value of Class I and a maximum value of Class IV.
Higher scores indicate poorer visualization of the oropharyngeal structures and a worse airway assessment, reflecting a greater likelihood of difficult laryngoscopy or difficult intubation.
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Preoperative airway assessment before induction of anesthesia
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Time to Successful Intubation
時間枠:During tracheal intubation procedure
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Time to successful intubation will be defined as the time, measured in seconds, from insertion of the laryngoscope into the oral cavity to confirmation of endotracheal tube placement by capnography.
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During tracheal intubation procedure
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Number of Intubation Attempts
時間枠:During tracheal intubation procedure
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The total number of laryngoscopy attempts required for successful endotracheal intubation will be recorded.
An intubation attempt will be defined as each insertion of the laryngoscope into the oral cavity with the intention of endotracheal tube placement.
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During tracheal intubation procedure
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Need for Adjunct Airway Maneuvers or Devices
時間枠:From induction of anesthesia until confirmation of successful endotracheal tube placement by capnography during the airway management procedure
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The need for adjunct airway maneuvers or devices will be recorded as a binary outcome, defined as whether any additional airway maneuver or device is required to achieve successful endotracheal intubation.
Adjuncts may include external laryngeal manipulation, stylet, bougie, change of laryngoscope, supraglottic airway device, or fiberoptic bronchoscopy.
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From induction of anesthesia until confirmation of successful endotracheal tube placement by capnography during the airway management procedure
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Peri-Intubation Oxygen Desaturation
時間枠:From anesthesia induction to 5 minutes after intubation
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Peri-intubation oxygen desaturation will be defined as a decrease in peripheral oxygen saturation below 90% during airway management.
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From anesthesia induction to 5 minutes after intubation
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Airway Trauma
時間枠:Immediately after intubation
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Airway trauma will be assessed by the presence of mucosal bleeding, dental trauma, lip injury, or other visible airway-related injury after intubation.
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Immediately after intubation
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Association Between Growth Hormone Level and Difficult Laryngoscopy
時間枠:Baseline preoperative assessment and during the tracheal intubation procedure
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Preoperative growth hormone levels will be recorded and analyzed for their association with the modified Cormack-Lehane grade and difficult laryngoscopy.
Difficult laryngoscopy will be assessed during tracheal intubation based on the modified Cormack-Lehane grade.
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Baseline preoperative assessment and during the tracheal intubation procedure
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Association Between Insulin-Like Growth Factor 1 Level and Difficult Laryngoscopy
時間枠:Preoperative baseline assessment and during the tracheal intubation procedure
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Preoperative insulin-like growth factor 1 levels and insulin-like growth factor 1 index will be recorded and analyzed for their association with the modified Cormack-Lehane grade and difficult laryngoscopy.
Difficult laryngoscopy will be assessed during tracheal intubation based on the modified Cormack-Lehane grade.
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Preoperative baseline assessment and during the tracheal intubation procedure
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協力者と研究者
協力者
協力者
出版物と役立つリンク
一般刊行物
- Friedel ME, Johnston DR, Singhal S, Al Khalili K, Farrell CJ, Evans JJ, Nyquist GG, Rosen MR. Airway management and perioperative concerns in acromegaly patients undergoing endoscopic transsphenoidal surgery for pituitary tumors. Otolaryngol Head Neck Surg. 2013 Dec;149(6):840-4. doi: 10.1177/0194599813507236. Epub 2013 Oct 3.
- Ali Z, Bithal PK, Prabhakar H, Rath GP, Dash HH. An assessment of the predictors of difficult intubation in patients with acromegaly. J Clin Neurosci. 2009 Aug;16(8):1043-5. doi: 10.1016/j.jocn.2008.11.002. Epub 2009 May 19.
- Zhang Y, Guo X, Pei L, Zhang Z, Tan G, Xing B. High levels of IGF-1 predict difficult intubation of patients with acromegaly. Endocrine. 2017 Aug;57(2):326-334. doi: 10.1007/s12020-017-1338-x. Epub 2017 Jun 15.
研究記録日
主要日程の研究
研究開始 (推定)
研究開始
一次修了 (推定)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
その他の研究ID番号
- ACRO-VL-2026
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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