Comparison of video assisted fiber-optic bronchoscopy with hyperangulated video laryngoscopy for first attempt success rate of intubation

Not Applicable

Recruiting

Conditions: Medical and Surgical,

Registration Number: CTRI/2025/05/086973

Lead Sponsor: AIIMS Bibinagar

Brief Summary: The study will commence after receiving approval from institutional research committee, institutional ethics committee and CTRI. Based on the inclusion criteria, patients will be recruited for the study. Written informed consent of patients will be taken after giving a detailed information about our study in terms of nature of study, the benefits and risks involved.Fiber optic intubation, despite being the current gold standard for anticipated difficult airway, does not provide a 100% success rate. . One of the main problems with fiber optic intubation, the narrow pharynx, can be solved through simultaneous direct or video laryngoscopy with elevation of the oropharynx. This is also helpful in case of tongue swelling or presentation with a large epiglottis. Therefore, VAFI helps the two instruments complement each other’s shortcomings. Hence VAFI has even been suggested to be includedin the difficult airway algorithm –non-emergent pathway. this study aimed to Video-laryngoscope-assisted fiber-optic bronchoscopic oro-tracheal intubation superior to hyperangulated video –laryngoscopic intubation in terms of first attempt success rate. Pre- anaesthetic evaluation along with anticipated difficult airway will be done prior to day of surgery.After shifting patient onto operation theatre table, in supine position, patient will be pre-oxygenated for 3 minutes followed by induction with Fentanyl 2mcg/kg and Propofol 2-3mg/kg titrated to loss of consciousness. Once mask ventilation is found to be successful, muscle relaxant Rocuronium 0.6mg/kg IBW will be given. The operator will then be informed of the group allotment of the patient~~.~~ Patient will be intubated with an endo-tracheal tube of appropriate size under video laryngoscopy (**C-MAC with D-Blade** (**Karl Storz**, Tuttlingen, Germany)) with the help of preformed stylet (C-MAC GUIDE, D-BLADE (Karl Storz, Tuttlingen, Germany)) or FOB (**EB**-**580S** (**FUJIFILM** Co., Tokyo, Japan)(outer diameter : 5.3mm) based on group allotment. Two operators will be involved in case of VAFOBI group. Time period from insertion of blade into oral cavity to appearance of ETCO2 will be noted, which indicates successful intubation. The attempt will be considered a failure if VLS is removed from the oral cavity or if Spo2 drops below 90% before achieving intubation. Patient will then be handed over to the surgeon for the surgery. The operator will then be enquired about the ease of intubation on a Likert scale. After surgery, all patients will be shifted to PACU (post anaesthetic care unit). Patients will be discharged from PACU after complete recovery. all patients receive standard care during the study period.

Detailed Description: Not available

Recruitment & Eligibility

Status: Open to Recruitment

Sex: All

Target Recruitment: 60

Inclusion Criteria

Patients having difficult airway (defined as modified mallampati grading more than 3 and 4) undergoing general anaesthesia requiring endotracheal intubation.

Exclusion Criteria

Pregnancy or any other risk of aspiration which necessitates rapid sequence intubation.
Mouth opening less than 2 cm Planned awake or nasal intubation Elective nasal intubation Emergency surgery Patients who do not consent for the study.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To determine the first attempt intubation success rates of Video-laryngoscope-Assisted Fiber-optic Bronchoscopic intubation VAFOBI and Hyperangulated Video Laryngoscopic intubation (VLS) in patients with anticipated difficult airway	immediately after succesful intubation. (within 3 minutes)

Secondary Outcome Measures

Name	Time	Method
To compare the ease of intubation between the two methods	immediately after tracheal intubation (within 3 minutes)
To determine the time taken to intubate
Hemodynamic response to intubation	Baseline (immediately before intubation), after that every two minutes for atleast 3 readings after successful intubation.
Incidence of airway injury and post-operative sore throat	24 hours following surgery

Trial Locations

Locations (1): AIIMS Bibinagar
🇮🇳
Nalgonda, TELANGANA, India
AIIMS Bibinagar
🇮🇳Nalgonda, TELANGANA, India
Ayya Syama Sundar
Principal investigator
8179309677
sasyasyama@gmail.com