To compare the time to successful intubation in Video Laryngoscopy and Direct Laryngoscopy in Paediatric patients undergoing planned surgery under General Anaesthesia.

Phase 4

Not yet recruiting

Conditions: Medical and Surgical,

Registration Number: CTRI/2023/08/056258

Lead Sponsor: Rajendra Institute of Medical Sciences Ranchi

Brief Summary: Endotracheal intubation is an essential skill performed by multiple medical specialists to secure a patientâ€™s airway as well as provide oxygenation and ventilation. There are multiple techniques available, including the visualization of the vocal cords with a (conventional) laryngoscope or video laryngoscope, direct placement of the endotracheal tube into the trachea via cricothyrotomy, and fibreoptic visualization of the vocal cords via the nasal or oral route. The goal of endotracheal intubation in the emergency setting is to secure the patientâ€™s airway and obtain first-pass success. There are many indications for endotracheal intubation, including poor respiratory drive, questionable airway patency, hypoxia, and hypercarbia. These indications are assessed by evaluating the patientâ€™s mental status, conditions that may compromise the airway, level of consciousness, respiratory rate, respiratory acidosis, and level of oxygenation. In the setting of trauma, a Glasgow Coma Scale of 8 or less is generally an indication for intubation. The risks and benefits of endotracheal intubation should be assessed as would be done with any other procedure. Patients whose respiratory status might improve with less invasive methods should be tried on modalities such as non-invasive positive pressure ventilation or other modes of oxygenation. Severe orofacial trauma can obstruct oropharyngeal intubation due to significant bleeding or disruption of the facial and upper airway anatomy. Cervical spine manipulation during intubation can be harmful to patients with spine injury and immobility. In the setting of these clinical situations, other modes of ventilation and oxygenation should be undertaken if the clinical condition allows. If a definitive airway is required, providers should be prepared for the potential of a surgical airway. There are no absolute contraindications to intubation, and the decision to place a definitive airway should take into consideration each patientâ€™s unique clinical condition. Tracheal intubation by video laryngoscope is the most innovative advancement and a completely different experience as compared with conventional Macintosh laryngoscope, and skills needed for the former method of indirect laryngoscopy are very different from those needed for direct laryngoscopy by Macintosh or Miller blade laryngoscopes. The latter method definitely requires training to be an experienced laryngoscopist and tracheal intubator, while in case of video laryngoscopy (VL), even the novices can successfully do laryngoscopy and intubate the trachea. The VL is visualization of an enlarged video image of airway structures. In contrast, using conventional laryngoscopy, anesthesiologists have only a narrow view of the airway structures, which can be further obscured during attempts to pass the endotracheal tube (ETT), and therefore, sometimes the ETT may slip into oesophagus. A direct laryngoscopy allows visualization of the larynx. It is used during general anaesthesia, surgical procedures around the larynx, and resuscitation. This tool is useful in multiple hospital settings, from the emergency department to the intensive care unit and the operating room. By visualizing the larynx, endotracheal intubation is facilitated. This is an important step for a range of patients who are unable to secure their own airway, including those with altered mental status and those who are undergoing a surgical procedure. When using direct laryngoscopy to secure a patientâ€™s airway, the physician must be well acquainted with the anatomy, indications, contraindications, preparation, equipment, proper technique, personnel, and complications of the procedure for successful endotracheal intubation.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 70

Inclusion Criteria

ASA status type I or II.
Elective Surgery requiring General Anaesthesia with tracheal intubation.
Informed consent by the Patientâ€™s legal representatives.

Exclusion Criteria

Patient/Parent/Legal Guardian unwilling.
Case of Head Injury.
Case of Emergency cases.
Case of Aspiration of Foreign Body.
Other comorbidities.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To compare the time to successful intubation in Video Laryngoscopy & Direct Laryngoscopy in Paediatric patients undergoing Elective Airway Management.	At the time of intubation.

Secondary Outcome Measures

Name	Time	Method
a. To find out the frequency of attempts to intubate.
To determine the incidence of complications like airway trauma, bronchospasm, hypoxia, & oesophageal intubation.	At the time of intubation
To determine the Percentage of Glottic Opening Visible (POGO score).	At the time of intubation.
To determine Cormack Lehane grading.	At the time of intubation.

Trial Locations

Locations (1): Rajendra Institute of Medical Sciences, Ranchi
🇮🇳
Ranchi, JHARKHAND, India
Rajendra Institute of Medical Sciences, Ranchi
🇮🇳Ranchi, JHARKHAND, India
Dr Peter Marandi
Principal investigator
7762925242
petermarandi08@gmail.com