Optimal Head and Neck Position During Videolaryngoscopy
- Conditions
- Head and Neck Position for Intubation
- Interventions
- Other: King Vision VideolaryngoscopeOther: C-Mac D-Blade Videolaryngoscope
- Registration Number
- NCT02558036
- Brief Summary
Optimal patient head and neck position when performing videolaryngoscopy for endotracheal intubation has not yet been established.The investigators aim to assess the effect of two different positions on the laryngeal view obtained and success of tracheal intubation during videolaryngoscopy with two commercially available and well established videolaryngoscopes.
- Detailed Description
The optimum patient head and neck position for direct laryngoscopy (when the anaesthetist views the larynx with a curved metallic blade before passing a tube for ventilation of the lungs) is traditionally considered to be the "sniffing the morning air" (neck flexion and head extension) position. This has been questioned previously as there is no randomized controlled study to date to explore this statement. The patient should be optimally positioned prior to induction of anaesthesia, especially because in the event of an unexpected difficult intubation, the Difficult Airway Society guidelines suggest the use of an alternative laryngoscope. In current clinical practice a videolaryngoscope (a curved blade with a camera attached to it that allows the anaesthetist to see around corners) has been used as an alternative laryngoscope. To the best of our knowledge, the ideal patient position for videolaryngoscopy has not yet been described. The intubation time and rate of success at intubation using a C-Mac D-Blade videolaryngoscope was previously assessed by Serocki et al, but only in the sniffing position. It is possible that adopting a different position when using the C-Mac D- Blade might result in a superior view of the larynx. Furthermore, the optimal patient position has not yet been assessed for intubation with the King Vision videolaryngoscope.
This key information could gain precious seconds in a difficult airway scenario (when securing the airway with a tube for ventilation proves difficult) and has obvious implications for patient management. The answer to this question could also help the anaesthetists take informed decisions when using videolaryngoscopy to intubate the trachea in elective settings. The investigators aim to assess the effect of two different positions on the laryngeal view obtained during videolaryngoscopy with two commercially available and well established videolaryngoscopes to try and answer this question.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 200
- All patients aged 18 and above, presenting for elective surgical procedure and requiring tracheal intubation will be invited to take part in the study.
- Patients who are refusing to take part, below 18 years of age, pregnant women, American society of anaesthesiologists' class 4 and above, those requiring rapid sequence indication, super morbidly obese (BMI >50) and those patients requiring awake fibreoptic intubation will be excluded.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description King Vision Neutral Position King Vision Videolaryngoscope King Vision videolaryngoscope with patients head and neck in neutral position. C-Mac D-Blade Sniffing Position C-Mac D-Blade Videolaryngoscope C-Mac D-Blade videolaryngoscope with patients head and neck in sniffing position. King Vision Sniffing Position King Vision Videolaryngoscope King Vision videolaryngoscope with patients head and neck in sniffing position. C-Mac D-Blade Neutral Position C-Mac D-Blade Videolaryngoscope C-Mac D-Blade videolaryngoscope with patients head and neck in neutral position.
- Primary Outcome Measures
Name Time Method Optimal Head and Neck Position during Videolaryngoscopy 6 months This will be assessed using a Difficult Intubation Scale Score for each of the 2 videolaryngoscopes used in the study, which will be assessed in both neutral and sniffing positions.
- Secondary Outcome Measures
Name Time Method Laryngoscopy Time Less than 1 minute From when the laryngoscope enters the mouth until achieving the best view of the larynx.
Intubation Time Less than 1 minute from entering the mouth with the videolaryngoscope until endotracheal tube is inserted in the wind-pipe and the capnography trace is first visible on the screen.
Trial Locations
- Locations (1)
University Hospitals Coventry & Warwickshire NHS Trust
🇬🇧Coventry, United Kingdom