Comparison of the Effects of Intubation With a Machintosh Laryngoscope, McGrath Videolaryngoscope and C-Mac Videolaryngoscope on Intra-ocular Pressure, Optic Nerve Sheath Diameter and Haemodynamic Parameters
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Inonu University
- Enrollment
- 120
- Locations
- 2
- Primary Endpoint
- Intraocular pressure-5
Study Overview
Brief Summary
Brief Summary:
In this study, the investigators aimed to compare the effects of different types of endotracheal instruments (Machintosh laryngoscope, McGrath videoingoscope and C-Mac videoryngoscope) on intraocular pressure, optic nerve diameter and hemodynamic parameters.
Detailed Description
Detailed Description:
Laryngoscopy and endotracheal intubation cause increased intracranial pressure due to hypoxia, hypercapnia, straining, or coughing. It may be an indirect result of increased arterial and venous pressure, as well as a direct effect of intubation.
With the emergence of neuroimaging techniques and new diagnostic tools, various methods have been developed that can replace invasive methods, which are the gold standard in intraocular pressure measurement. However, invasive methods such as intraventricular and intraparenchymal catheter systems have some disadvantages and are associated with significant risks in terms of infection, bleeding, and time lost until follow-up.
The intraorbital subarachnoid space surrounding the optic nerve shows the same pressure variation as the intracranial subarachnoid space, and any increase in intracranial pressure is also seen in the orbital subarachnoid space. With the increase in intracranial pressure, the optic nerve, optic nerve sheath diameter, and subarachnoid space enlarge. There are many studies reporting that optic nerve sheath diameter can be evaluated using ultrasonography. Although there is no clear cut-off value for optic nerve sheath diameter, previous studies have found that an optic nerve sheath diameter of 5.0 mm and above may indicate an increase in intracranial pressure.
Previous studies have determined that the distribution of intraocular pressure in the adult population varies between 11 mmHg and 21 mmHg, and the mean intraocular pressure is 16.5 mmHg. It is well known that the sympathoadrenergic response caused by laryngoscopy and tracheal intubation significantly increases intraocular pressure (at least 10-20 mmHg). In addition, intravenous pressure and intraocular pressure increase due to cough, airway obstruction, succinylcholine use, hypoxia and hypercapnia during intubation.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description
Single (Participant)
Eligibility Criteria
- Ages
- 18 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Non-ophthalmic surgery
- •Mallampati I or II classifications
- •American Society of Anesthesiologists (ASA) I-II
Exclusion Criteria
- •Glaucoma,
- •Diabetes mellitus,
- •Cardiovascular diseases,
- •Pulmonary diseases,
- •ASA 3 and 4
- •Body Mass Index (BMI) greater than 30
- •Eye surgery
- •Difficult intubation (Mallampati score of 3 or 4, thyromental distance of less than 6 cm and a maximum mouth opening of less than 3 cm)
- •Intraocular pressure value more than 20 mmHg
- •More than two intubation attempts
- •A risk of regurgitation patients
- •History of obstetric surgery
- •Allergies to propofol, fentanyl or rocuronium
Outcomes
Primary Outcomes
Intraocular pressure-5
Time Frame: Intraocular pressure will be measured at 10 minutes after intubation
Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.
Intraocular pressure-2
Time Frame: Intraocular pressure will be measured at just before laryngoscopy and intubation
Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.
Intraocular pressure-3
Time Frame: Intraocular pressure will be measured at immediately after intubation
Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.
Intraocular pressure-1
Time Frame: Intraocular pressure will be measured at before induction
Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.
Intraocular pressure-4
Time Frame: Intraocular pressure will be measured at 5 minutes after intubation
Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.
Secondary Outcomes
- Optic nerve diameter measurement-2(Optic nerve diameter measurement-2 will be measured at just before laryngoscopy and intubation)
- Optic nerve diameter measurement-5(Optic nerve diameter measurement-5 will be measured at 10 minutes after intubation)
- Optic nerve diameter measurement-3(Optic nerve diameter measurement-3 will be measured at immediately after intubation)
- Optic nerve diameter measurement-4(Optic nerve diameter measurement-4 will be measured at 5 minutes after intubation)
- Optic nerve diameter measurement-1(Optic nerve diameter measurement-1 will be measured at before induction)
Investigators
Erol Karaaslan
Associate Professor
Inonu University