Comparison of Glottic Views and Intubation Times in the Supine and 25 Degree Back-up Positions
NCT ID: NCT02934347
Last Updated: 2017-05-11
Study Results
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View full resultsBasic Information
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COMPLETED
781 participants
OBSERVATIONAL
2012-02-29
2015-01-31
Brief Summary
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Detailed Description
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However the sniffing position does not guarantee adequate exposure in all patients because many other anatomical factors control the final degree of visualization.
To achieve a proper sniffing position in obese patients, the "ramped" (or the back-up) position has been used as this produces better neck flexion and head extension in these patients when compared to the horizontal supine position. Also the forces required to elevate and move the tongue and other tissues out of the line of sight are less when the patients are ramped.
Our hypothesis is that the view of the glottis may be improved by putting all (ie not only obese) patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.
Conditions
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Study Design
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CASE_CONTROL
PROSPECTIVE
Study Groups
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Supine
A baseline group of adult patients who required intubation as part of their routine anaesthesia who were intubated in the standard horizontal sniffing position.
No interventions assigned to this group
Back-up
A subsequent group of similar the patients who had their anaesthesia induced and tracheas intubated in a 25 degree back-up position achieved by flexion of the operating table at the hips
25 degree back-up position
To test whether a 25 degree back-up position improves laryngeal views and makes intubation easier compared to the standard horizontal position
Interventions
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25 degree back-up position
To test whether a 25 degree back-up position improves laryngeal views and makes intubation easier compared to the standard horizontal position
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
2. Patients recognised to have difficult airways where an alternative method of intubation (e.g. fibre optic) was the method of choice,
3. Patients undergoing emergency surgery where patient positioning and data collection might cause delay (e.g. exsanguinating patients) or where the supine position is not optimal (e.g. brisk bleeding into the upper airway),
4. Patients requiring rapid sequence induction of anaesthesia
18 Years
ALL
No
Sponsors
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Betsi Cadwaladr University Health Board
OTHER_GOV
Responsible Party
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Raj M Reddy
Consultant Anaesthetist
Principal Investigators
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Raj M Reddy, FRCA
Role: PRINCIPAL_INVESTIGATOR
Anaesthetic Department, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board
References
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Adnet F, Baillard C, Borron SW, Denantes C, Lefebvre L, Galinski M, Martinez C, Cupa M, Lapostolle F. Randomized study comparing the "sniffing position" with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology. 2001 Oct;95(4):836-41. doi: 10.1097/00000542-200110000-00009.
Bannister FB, Macbeth RG. Direct laryngoscopy and tracheal intubation. Lancet 1944; 2: 651-4
Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth. 2010 Nov;105(5):683-90. doi: 10.1093/bja/aeq239. Epub 2010 Sep 15.
Jackson C. Bronchoscopy and Esophagoscopy: A Manual of Peroral Endoscopy and Laryngeal Surgery. Philadelphia and London: WB Saunders; 1922
Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007 Oct;99(4):581-6. doi: 10.1093/bja/aem095. Epub 2007 Jul 4.
Lee HC, Yun MJ, Hwang JW, Na HS, Kim DH, Park JY. Higher operating tables provide better laryngeal views for tracheal intubation. Br J Anaesth. 2014 Apr;112(4):749-55. doi: 10.1093/bja/aet428. Epub 2013 Dec 18.
Rao SL, Kunselman AR, Schuler HG, DesHarnais S. Laryngoscopy and tracheal intubation in the head-elevated position in obese patients: a randomized, controlled, equivalence trial. Anesth Analg. 2008 Dec;107(6):1912-8. doi: 10.1213/ane.0b013e31818556ed.
Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions. Obes Surg. 2004 Oct;14(9):1171-5. doi: 10.1381/0960892042386869.
Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005 Nov;60(11):1064-7. doi: 10.1111/j.1365-2044.2005.04374.x.
Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, Laurie CP, O'Brien PE. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005 Jun;102(6):1110-5; discussion 5A. doi: 10.1097/00000542-200506000-00009.
Lebowitz PW, Shay H, Straker T, Rubin D, Bodner S. Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals. J Clin Anesth. 2012 Mar;24(2):104-8. doi: 10.1016/j.jclinane.2011.06.015. Epub 2012 Feb 1.
Reddy RM, Adke M, Patil P, Kosheleva I, Ridley S; Anaesthetic Department at Glan Clwyd Hospital. Comparison of glottic views and intubation times in the supine and 25 degree back-up positions. BMC Anesthesiol. 2016 Nov 16;16(1):113. doi: 10.1186/s12871-016-0280-4.
Other Identifiers
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BetsiCUHB
Identifier Type: -
Identifier Source: org_study_id
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