Ultrasound-Guided Airway Nerve Blocks vs. Lidocaine Topical Anesthesia Using Video-Assisted Laryngoscopy in Suspected Difficult Intubation for Patients Undergoing Bariatric Surgery
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Ain Shams University
- Enrollment
- 80
- Locations
- 1
- Primary Endpoint
- Incidence of Gag reflex and cough reflex
Study Overview
Brief Summary
The investigators will test the effects of ultrasound guided airway nerve block vs lidocaine topical anesthesia and it's direct effect in decreasing incidence of gag and cough reflex in suspected difficult intubation patients using video assisted laryngoscopey for those Undergoing bariatric surgery
Detailed Description
A.Preoperative settings:
A thorough preoperative evaluation including a complete airway evaluation (mouth opening, mallampati grading, body weight, thyromental distance, and evaluation of dentition) will be performed. Standard fasting guidelines and anti-aspiration prophylaxis with tablet ranitidine 150 mg will be prescribed.
The patients will be explained about the awake C-MAC intubation during preoperative assessment.Injection of atropine 0.4 mg will be given half an hour before shifting the patient to the operating room (OR).
B.Intraoperative and postoperative settings:
Injection of atropine 0.4 mg will be given half an hour before shifting the patient to the operating room (OR). Inside the OR, standard monitoring, including electrocardiography (ECG), noninvasive blood pressure (BP), and pulse oximetry (SpO2) will be applied in all patients. An intravenous (IV) line will be secured and ringer lactate will be started. After recording the baseline heart rate (HR), BP and SpO2, Injection of Dexametomidate 0.7 mcg/kg/hr IV infusion and injection ketamine 0.5-2 mg/kg slow IV single dose until endotracheal tube secured.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 21 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Age: 21-65 years old
- •Obese patients (BMI>35 kg/m2) undergoing bariatric surgery
- •Suspected difficult intubation: e.g:(Mallampati score ≥3 , Thyromental distance <6 cm, Limited neck mobility, History of difficult intubation)
Exclusion Criteria
- •Patients at increased risk for aspiration (e.g., full stomach or gastro-esophageal reflux disease) and pregnancy
- •Patients with expected difficult ventilation
- •Patients who have upper airway pathology or surgery
- •Patients with a mouth opening < 2 cm
- •Emergency surgery
- •Allergy to local anesthetics
- •Contraindication to nerve blocks e.g.:(Coagulopathy, Infection at site of injection)
- •Patient refusal
- •Neurological or cognitive impairment making the patient uncooperative
- •History of difficult airway complications e.g.: previous intubation failure or need for surgical airway
- •Cervical spine instability or fractures
Arms & Interventions
Group LA
patients will be intubated using the video-assisted laryngoscope after taking airway nerves block guided by ultrasound device
Intervention: Ultrasound guided airway nerve block for Endotracheal intubation (Procedure)
Group T
patients will be intubated using the video-assisted laryngoscope after topical lidocaine 10% spraying as-you-go to oro-pharyngeo-laryngeal cavity without exceeding the toxic dose.
Intervention: lidocaine topical anesthesia for Endotracheal intubation (Procedure)
Outcomes
Primary Outcomes
Incidence of Gag reflex and cough reflex
Time Frame: After applying local anesthesia by at least 3 minutes
After taking local anesthesia monitoring of gag and cough reflexes will be monitored during the process of endotracheal intubation
Secondary Outcomes
- Mean blood pressure (MAP)(After applying local anesthesia by at least 3 minutes)