New Position for Endotracheal Intubation of Obese Patients: a Randomized Controlled Comparison With the Ramped Position
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 52
- 试验地点
- 2
- 主要终点
- Time for endotracheal intubation
研究概览
简要总结
The aim of this work is to investigate the feasibility of using the modified a ramped position for mask ventilation and endotracheal intubation of obese patients in comparison to the traditional ramped position
详细描述
Adequate conditions for endotracheal intubation and mask ventilation require appropriate positioning of head and neck. The sniffing position had been described as the most appropriate head position for endotracheal intubation. Sniffing position is achieved through two main components: flexion of the neck by 35° (achieved by head elevation) and extension of the head by 15° 2 to have the sternum at the same level of external auditory meatus 34. Sniffing position has the advantage of alignment of the three axes: oral, pharyngeal, and laryngeal axes for reaching the optimal laryngeal visualization.
In obese patients, it is recommended to put the patient in the ramped position (back-up position with the tragus of the ear is at the level of the suprasternal notch) in addition to the sniffing head-and-neck position.
In addition to difficult laryngeal visualization, another problem commonly confronts anesthetists during intubation of obese such as: 1- Impedance to complete mouth opening due to fatty face and neck. 2- Impedance of laryngoscopy by large breasts in females. This problem commonly hinders the intubation process and might lead to serious hypoxia. Most of the positions described in literature were concerned with facilitating laryngeal visualization. No position to the best of our knowledge was applied to aid the introduction of the laryngoscope.
The investigators hypothesized that using a special pillow to achieve a modified ramped position (by slight extension of the neck) at the beginning of the laryngoscopy would enhance mouth opening and bring the breasts away from the laryngoscope. After successful introduction of the laryngoscope in the oral cavity, the head could be manually elevated (if required) to achieve sniffing position.
The aim of this work is to investigate the feasibility of using the aforementioned modified ramped position for intubation of obese females in comparison to the traditional ramped position.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •female patients
- •obese (with body mass index above 30 kg per squared meter)
- •Scheduled for surgery under general anesthesia.
排除标准
- •Patients with scars in the face or neck.
- •Edentulous patients.
- •Patients with airway masses.
结局指标
主要结局
Time for endotracheal intubation
时间窗: 5 minutes after induction of general anesthesia
Defined as the time measured in seconds from handling the laryngoscope till confirmation of correct position of endotracheal tube
次要结局
- Time of laryngoscopy(5 minutes after induction of general anesthesia)
- Oxygen saturation(5 minutes after induction of general anesthesia)
- End-tidal carbon dioxide(5 minutes after induction of general anesthesia)
- Heart rate(5 minutes after induction of general anesthesia)
- Incidence of difficult laryngoscopy(5 minutes after induction of general anesthesia)
- Incidence of difficult mask ventilation(5 minutes after induction of general anesthesia)
研究者
Ahmed Hasanin
Assistant professor of anesthesia and critical care
Cairo University