Retromolar Route Access With and Without A Retromolar Gap
NCT ID: NCT02611141
Last Updated: 2018-03-22
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
40 participants
INTERVENTIONAL
2015-11-30
2017-07-31
Brief Summary
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Therefore the investigators want to test if the retromolar gap is essential for performing the retromolar intubation technique.
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Detailed Description
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Therefore, 20 patients with and 20 patients without a retromolar gap will be investigated.
The anesthesiologist will visually determine the view of the vocal cords and score it according to Cormack \& Lehane. For an improved view a backward, upward, right-ward pressure (BURP) will be performed, if needed, and scored again.
Finally, endotracheal intubation will be performed by the 'conventional' intubation method. If, however, intubation is not possible, then the retromolar technique will be used. In the case that both methods fail, then any (other) intubation method will (can) be used.
Conditions
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Study Design
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NON_RANDOMIZED
PARALLEL
OTHER
NONE
Study Groups
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Patient with Retromolar Gap
20 patients with a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible.
Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane
To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack \& Lehane .
This score will be assessed at least 2 minutes after muscle relaxation:
1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later):
2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again.
Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used.
Patient without a Retromolar Gap
20 patients without a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible.
Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane
To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack \& Lehane .
This score will be assessed at least 2 minutes after muscle relaxation:
1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later):
2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again.
Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used.
Interventions
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Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane
To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack \& Lehane .
This score will be assessed at least 2 minutes after muscle relaxation:
1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later):
2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again.
Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used.
Eligibility Criteria
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Inclusion Criteria
* Elective surgery
* Absence of at least one molar of the right mandible in arm I (20 patients)
Exclusion Criteria
* Prevalence of reflux disease
* Toothless patients
* Diaphragmatic hernia
* Patient is not sober
* Ventilation problems during induction of anaesthesia
* Patient with a tracheostomy
18 Years
99 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. med. univ.
Locations
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Medical University of Vienna
Vienna, , Austria
Countries
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References
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Ranieri D Jr, Filho SM, Batista S, do Nascimento P Jr. Comparison of Macintosh and Airtraq laryngoscopes in obese patients placed in the ramped position. Anaesthesia. 2012 Sep;67(9):980-5. doi: 10.1111/j.1365-2044.2012.07200.x. Epub 2012 Jun 1.
De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, Jung B, Chanques G, Jaber S. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014 May;40(5):629-39. doi: 10.1007/s00134-014-3236-5. Epub 2014 Feb 21.
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.
Henderson JJ. Questions about the macintosh laryngoscope and technique of laryngoscopy. Eur J Anaesthesiol. 2000 Jan;17(1):2-5. doi: 10.1046/j.1365-2346.2000.00611.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.
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.
Bonfils P. [Difficult intubation in Pierre-Robin children, a new method: the retromolar route]. Anaesthesist. 1983 Jul;32(7):363-7. German.
Martinez-Lage JL, Eslava JM, Cebrecos AI, Marcos O. Retromolar intubation. J Oral Maxillofac Surg. 1998 Mar;56(3):302-5; discussion 305-6. doi: 10.1016/s0278-2391(98)90103-3.
Other Identifiers
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1848/2015
Identifier Type: -
Identifier Source: org_study_id
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