A scan to measure distance between tongue and palate to assess difficuty in holding oxygen mask during anaesthesia-an observational study.

Not yet recruiting

Conditions: Other and unspecified acute appendicitis,

Registration Number: CTRI/2021/12/038781

Lead Sponsor: JIPMER

Brief Summary: After obtaining approval from postgraduate research monitoring committee and ethical committee and registering in CTRI, patients satisfying the eligibility criteria will be enrolled for the study after obtaining written informed consent. Preoperative assessment will be done by the attending anesthesiologist one day before surgery. The patientâ€™s information, medical history will be obtained. Physical examination includes height, weight, body mass index (BMI). Airway evaluation includes Modified Mallampatti score, mouth opening (fingers breath), neck extension, upper lip bite test. A flexible ruler will be used to measure airway parameters hyomental distance (cm), thyromental distance (cm), sternomental distance (cm). The patient will be explained about ultrasonography procedure and ultrsonography will be performed in sniffing postion.The space between tongue and palate will be measured by ultrasound machine (esaote My lab x5). A 1-8MHz frequency curvilinear ultrasound probe will be used to get the submandibular view, and the space between the tongue and palate will be measured in the coronal and saggital plane by placing probe at mentohyoid junction. The thickness of the tongue will be measured in saggital plane as the maximum vertical dimension from submental skin to the dorsal surface of the tongue at mentohyoidjunction.The ultrasound assessment will be done by a person who has done atleast 20 senior assisted assessments before.On the day of surgery, standard monitoring including ECG, NIBP, Pulse rate, SpO2 will beconnected and monitored in the OT table. IV line will be secured. Preoxgenation for 3mintues willbe done . Equipment for managing difficult airway will be kept ready. The technique of inductionwill be decided by the attending anesthesiologist. After induction, the patient will be paralyzedwith non depolarising muscle relaxant and manual mask ventilation will be done. The maskventilation will be done by a resident with more than one year training. Using 2 hands to holdmask, use of airway device to assist mask ventilation, using airway pressures more than 20cmH2O,increasing oxygen flow, change of operator will be noted. The difficulty in mask ventilation isgraded using the grading system described by Han et al.9Grade DescriptionGrade 0Mask ventilation not attemptedGrade 1Easy ventilation with maskGrade 2Ventilated with mask using airway adjunctsGrade 3Inadequate, unstable, requires 2 operatorsGrade 4Unable to mask ventilateGrade 0 and grade 1,2 will be considered as easy, grade 3 ,4 will be considered as difficultventilation. If the difficulty in mask ventilation was because of leak around the mask, the patientwill be withdrawn from the study. Laryngoscopy will be done by a resident with more than oneyear training with head extended at atlanto-occipital joint by keeping head ring and neck flexedon thorax by keeping pillow under shoulder using Mcintosh curved laryngoscopy blade of size 3or 4. During laryngoscopy, the Cormack Lehane grading will be noted. The Cormack Lehanegrades 1 and 2 will be designated as easy , grades3 and 4 will be designated as difficultlaryngoscopy. The Cormack-Lehane grading system â€“for laryngoscopic view:Grade 1 is visualization of the entire laryngeal aperture.Grade 2 is visualization of only the posterior portion of the laryngeal aperture.Grade 3 is visualization of only the epiglottis.Grade 4 is no visualization of the epiglottis or larynx.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 128

Inclusion Criteria

Inclusion criteria All patients aged above 18 years posted for surgical procedures under general anesthesia with endotracheal tube.

Exclusion Criteria

Exclusion criteria 1.
Patients with gross facial anomalies 2.
Nasal blockade 3.
Facial injuries/trauma patients 4.
Planned rapid sequence induction 5.
Pregnancy 6.
Difficulty in positioning for intubation 7.
Reduced mouth opening 8.
Contraindication for using non depolarizing muscle relaxant 9.
Difficulty in performing ultrasound assessment.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To determine the sensitivity and specificity of	One day before surgery USG measurement will be done and next day in operation theatre till intubation patient will be participating in this study
palatoglossal space as seen by ultrasonography to	One day before surgery USG measurement will be done and next day in operation theatre till intubation patient will be participating in this study
predict difficult mask ventilation.	One day before surgery USG measurement will be done and next day in operation theatre till intubation patient will be participating in this study

Secondary Outcome Measures

Name	Time	Method
To determine the sensitivity and specificity of	palatoglossal space and tongue thickness as seen

Trial Locations

Locations (1): JIPMER
🇮🇳
Pondicherry, PONDICHERRY, India
JIPMER
🇮🇳Pondicherry, PONDICHERRY, India
sarath
Principal investigator
9159010530
saraths00067@gmail.com