Study Results
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Basic Information
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COMPLETED
NA
100 participants
INTERVENTIONAL
2013-07-31
2015-03-31
Brief Summary
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Detailed Description
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For the present clinical investigation, 100 patients undergoing elective surgery will be investigated in the General Hospital of Vienna when for the anaesthesia intubation is required. In both intubation methods (RM and CM) the anaesthesiologist will visually determine the Cormack \& Lehane score in a randomly assigned sequence with and without a BURP-manoeuvre (= backwards, upwards and rightwards pressure). Thereafter intubation is performed in all patients by the CM method and if intubation fails the RM technique will be used. Of course, as per usual, every intubation trial is interrupted by a 20 second 100%-oxygen-ventilation period to reach a pulse oximetry oxygen saturation of at least 97% SpO2. Thereafter, if intubation fails again every other intubation technique will be applied, as necessary and called for.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
NONE
Study Groups
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Retromolar
Patients in whom the vocal cord visualisation starts with the retromolar method, which has been randomized determined preoperatively.
The second visualization then will be performed with the conventional method.
Retromolar Vocal Cord Visualisation
For easier insertion of the laryngoscope the head of the patient will be turned to the left site. Thereafter the blade (Miller) will be inserted into the mouth and pushed carefully as far as possible laterally to receive a direct view of the vocal cords. Then the performing anesthesiologist determine the Cormack \& Lehane score without and thereafter with a BURP (backward upward rightward pressure) maneuver.
Conventional Vocal Cord Visualisation
The head of the patient will be positioned as usual. After 2 minutes oxygen insufflation the laryngoscope will be inserted laterally to push the tongue to the left side in order to release the sight to the vocal cords. Thereafter the anesthesiologist determines the Cormack \& Lehane score without and thereafter with performance of the BURP (backward upward rightward pressure) maneuver.
Convenvtional
Patients in whom the vocal cord visualisation starts with the conventional method, which has been randomized determined preoperatively.
The second visualization then will be performed with the retromolar method.
Retromolar Vocal Cord Visualisation
For easier insertion of the laryngoscope the head of the patient will be turned to the left site. Thereafter the blade (Miller) will be inserted into the mouth and pushed carefully as far as possible laterally to receive a direct view of the vocal cords. Then the performing anesthesiologist determine the Cormack \& Lehane score without and thereafter with a BURP (backward upward rightward pressure) maneuver.
Conventional Vocal Cord Visualisation
The head of the patient will be positioned as usual. After 2 minutes oxygen insufflation the laryngoscope will be inserted laterally to push the tongue to the left side in order to release the sight to the vocal cords. Thereafter the anesthesiologist determines the Cormack \& Lehane score without and thereafter with performance of the BURP (backward upward rightward pressure) maneuver.
Interventions
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Retromolar Vocal Cord Visualisation
For easier insertion of the laryngoscope the head of the patient will be turned to the left site. Thereafter the blade (Miller) will be inserted into the mouth and pushed carefully as far as possible laterally to receive a direct view of the vocal cords. Then the performing anesthesiologist determine the Cormack \& Lehane score without and thereafter with a BURP (backward upward rightward pressure) maneuver.
Conventional Vocal Cord Visualisation
The head of the patient will be positioned as usual. After 2 minutes oxygen insufflation the laryngoscope will be inserted laterally to push the tongue to the left side in order to release the sight to the vocal cords. Thereafter the anesthesiologist determines the Cormack \& Lehane score without and thereafter with performance of the BURP (backward upward rightward pressure) maneuver.
Eligibility Criteria
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Inclusion Criteria
* BMI \< 30kg/m2
* Elective surgery
* Absence of at least one molar of the right mandible
Exclusion Criteria
* Prevalence of reflux disease
* Toothless patients
* Diaphragmatic hernia
* Patient is not sober
* Ventilation problems during induction of anaesthesia
* Gastric regurgitation during induction of anaesthesia
* Patient with a tracheostomy
18 Years
ALL
No
Sponsors
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Medical University of Vienna
OTHER
Responsible Party
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Wolfgang SCHRAMM
Ao Univ. Prof. Dr.
Locations
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Medical University of Vienna
Vienna, Vienna, Austria
Countries
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References
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Beckmann LA, Edwards MJ, Greenland KB. Differences in two new rigid indirect laryngoscopes. Anaesthesia. 2008 Dec;63(12):1385-6. doi: 10.1111/j.1365-2044.2008.05777.x. No abstract available.
Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anaesthesia. 2011 Dec;66 Suppl 2:57-64. doi: 10.1111/j.1365-2044.2011.06935.x.
Cooper RM. Complications associated with the use of the GlideScope videolaryngoscope. Can J Anaesth. 2007 Jan;54(1):54-7. doi: 10.1007/BF03021900.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984 Nov;39(11):1105-11.
De Beer DA, Williams DG, Mackersie A. An unexpected difficult laryngoscopy. Paediatr Anaesth. 2002 Sep;12(7):645-8. doi: 10.1046/j.1460-9592.2002.00857.x.
Dhonneur G, Abdi W, Amathieu R, Ndoko S, Tual L. Optimising tracheal intubation success rate using the Airtraq laryngoscope. Anaesthesia. 2009 Mar;64(3):315-9. doi: 10.1111/j.1365-2044.2008.05757.x.
Henderson JJ. The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation. Anaesthesia. 1997 Jun;52(6):552-60. doi: 10.1111/j.1365-2222.1997.129-az0125.x.
Henderson JJ, Popat MT, Latto IP, Pearce AC; Difficult Airway Society. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004 Jul;59(7):675-94. doi: 10.1111/j.1365-2044.2004.03831.x.
Honarmand A, Safavi MR. Prediction of difficult laryngoscopy in obstetric patients scheduled for Caesarean delivery. Eur J Anaesthesiol. 2008 Sep;25(9):714-20. doi: 10.1017/S026502150800433X. Epub 2008 May 9.
Lee SS, Huang SH, Wu SH, Sun IF, Chu KS, Lai CS, Chen YL. A review of intraoperative airway management for midface facial bone fracture patients. Ann Plast Surg. 2009 Aug;63(2):162-6. doi: 10.1097/SAP.0b013e3181855156.
Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. doi: 10.1016/j.annemergmed.2010.05.035. Epub 2010 Jul 31.
Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985 Jul;32(4):429-34. doi: 10.1007/BF03011357.
Sahin M, Anglade D, Buchberger M, Jankowski A, Albaladejo P, Ferretti GR. Case reports: iatrogenic bronchial rupture following the use of endotracheal tube introducers. Can J Anaesth. 2012 Oct;59(10):963-7. doi: 10.1007/s12630-012-9763-z. Epub 2012 Jul 24.
Scott J, Baker PA. How did the Macintosh laryngoscope become so popular? Paediatr Anaesth. 2009 Jul;19 Suppl 1:24-9. doi: 10.1111/j.1460-9592.2009.03026.x.
Suzuki A, Abe N, Sasakawa T, Kunisawa T, Takahata O, Iwasaki H. Pentax-AWS (Airway Scope) and Airtraq: big difference between two similar devices. J Anesth. 2008;22(2):191-2. doi: 10.1007/s00540-007-0603-1. Epub 2008 May 25. No abstract available.
Takahata O, Kubota M, Mamiya K, Akama Y, Nozaka T, Matsumoto H, Ogawa H. The efficacy of the "BURP" maneuver during a difficult laryngoscopy. Anesth Analg. 1997 Feb;84(2):419-21. doi: 10.1097/00000539-199702000-00033.
Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults. Can J Anaesth. 2009 Jun;56(6):449-66. doi: 10.1007/s12630-009-9084-z. Epub 2009 Apr 28.
Thong SY, Wong TG. Clinical uses of the Bonfils Retromolar Intubation Fiberscope: a review. Anesth Analg. 2012 Oct;115(4):855-66. doi: 10.1213/ANE.0b013e318265bae2. Epub 2012 Sep 5.
Truong A, Truong DT. Retromolar fibreoptic orotracheal intubation in a patient with severe trismus undergoing nasal surgery. Can J Anaesth. 2011 May;58(5):460-3. doi: 10.1007/s12630-011-9474-x. Epub 2011 Feb 24.
Turkstra TP, Pelz DM, Jones PM. Cervical spine motion: a fluoroscopic comparison of the AirTraq Laryngoscope versus the Macintosh laryngoscope. Anesthesiology. 2009 Jul;111(1):97-101. doi: 10.1097/ALN.0b013e3181a8649f.
Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3.
Other Identifiers
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1386/2013
Identifier Type: -
Identifier Source: org_study_id
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