Macintosh Laryngoscope Assisted Fiberoptic Intubation

Not Applicable

Completed

• Conditions: Difficult Intubation
• Interventions: Device: fiberoptic, Machintosh; Device: fiberoptic, airway

• Registration Number: NCT03310866
• Lead Sponsor: Mansoura University

Brief Summary

During fiberoptic endotracheal intubation, the perfect airway exposure produced by the classic curved Macintosh laryngoscope in place of head tilt -chin lift-jaw thrust maneuver may increase the accuracy and produce rapid direct vocal cord access in a short time under Inhalation anesthesia to maintain the respiratory drive for grade III\&VI Modified Mallampati .

Detailed Description

Managing difficult airway is critical for anesthesia-related morbidity and mortality. Fiberoptic laryngoscope is a reliable tool for endotracheal intubation in difficult airway cases (Modified Mallampatti III\&IV), but always there is difficulty to visualize the glottis due to airway tendency to collapse, classically a specific fiberoptic airway with a side way is used and it may added head tilt chin lift jaw thrust. A new technique utilizing sevoflurane anesthesia to maintain the respiratory drive without exposing the patient to the stress of the awake airway instrumentation. Simultaneous utilization of both Macintosh curved laryngoscope and Fiberoptic bronchoscope during Endotracheal intubation (ETT) will be examined for the efficacy during difficult airway management.

All patients should be examined preoperatively for the scoring Modified Mallampati or non tongue protrusion mallampati (NT-MMT) airway score. The pharyngeal structures were then evaluated and the best view (lowest class) was recorded. The classification follows m-MMT and is as follows: class 1, full visibility of tonsils, uvula, and soft palate; class 2, visibility of hard and soft palate, upper portion of tonsils and uvula; class 3, visibility of the soft and hard palate and base of the uvula; and class 4, visibility of only the hard palate, class III or IV patients were included in the study. Inhalational anesthesia use maintains the respiratory drive of the patient allowing less stressful technique.

Study Timeline

• Study First Submitted: 2017-10-05
• Study First Submitted QC: 2017-10-10
• Study First Posted: 2017-10-16
• Study Start: 2017-12-15
• Primary Completion: 2018-07-15
• Study Completion: 2018-07-30
• Status Verified: 2018-10
• Last Update Submitted: 2018-10-04
• Last Update Posted: 2018-10-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Adult patients with Modified Mallampati (NT-MMT) airway score III,VI
• American Society of Anaesthesiologists (ASA) physical class I-III
• Scheduled for elective cancer surgery under general anesthesia

Exclusion Criteria

• Modified Mallampati I,II Airway scored patients.
• History of upper airway surgery.
• Patients with serious deformities of the mandible, maxilla, tongue, pharynx or larynx.
• Patients with a history of significant cardiac and pulmonary diseases,
• Obesity with BMI >40,
• Epilepsy, pregnancy, mental disease, neurological psychological disorders.
• Communication barrier.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
fiberoptic, Machintosh	fiberoptic, Machintosh	oral Fiberoptic bronchoscopic intubation assisted by Macintosh Laryngoscope, by 2 anesthetist
fiberoptic, airway	fiberoptic, airway	Classical fiberoptic intubation assisted by side fenestrated airway and head tilt- chin lift- jaw thrust by 2 anesthetist

Primary Outcome Measures

Name	Time	Method
intubation time	during intubation	time from introduction of the tip of the fiber optic laryngoscope till insertion of the tube in the laryngeal inlet down in the trachea in seconds.

Secondary Outcome Measures

Name	Time	Method
mean heart rate (HR)	during intubation till 5 minutes after intubation	basal, every minute during intubation, 1, 3, 5 minutes after intubation
lower jaw relaxation	during intubation	(Relaxed= 0, not fully=1, poor= 2)
Neck movements	during intubation and cuff inflation	for endotracheal tube or cuff inflation (no=0, slight= 1, vigorous= 2),
Vocal cord position	during intubation	(Abducted= 0, Intermediate opening= 1, Closed= 2)
Cough	during intubation and cuff inflation	(absent= 0, present=1)
1st trial success rate	during intubation	in percent
the number of trails	during intubation	(1st trial=1, 2nd trial= 2, 3rd trial= 3)
mean arterial Blood pressure (MBP)	during intubation till 5 minutes after intubation	basal, every minute during intubation, 1, 3, 5 minutes after intubation
desaturation (SpO2)	during intubation	oxygen saturation \<90% .(Yes=1, No= 0)

Trial Locations

Locations (1)

Oncolgy Center, Mansoura University,; 🇪🇬 Mansoura, Dakahlia, Egypt