Comparison of Glottic Views and Intubation Times in the Supine and 25 Degree Back-up Positions
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 781
- 主要终点
- The Best Glottic View Obtained During Laryngoscopy
研究概览
简要总结
Our hypothesis is that the view of the glottis may be improved by putting all patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.
详细描述
The sniffing position has traditionally been considered the optimal head position for direct laryngoscopy and is the usual patient position preferred by most anaesthetists. In theory, neck flexion aligns the pharyngeal and laryngeal axes, and head extension at the atlanto-occipital joint aligns the oral axis with these two axes allowing the line of sight to fall on the glottis. It is recognized as the starting head position for direct laryngoscopy because it provides the best chance of adequate exposure.
However the sniffing position does not guarantee adequate exposure in all patients because many other anatomical factors control the final degree of visualization.
To achieve a proper sniffing position in obese patients, the "ramped" (or the back-up) position has been used as this produces better neck flexion and head extension in these patients when compared to the horizontal supine position. Also the forces required to elevate and move the tongue and other tissues out of the line of sight are less when the patients are ramped.
Our hypothesis is that the view of the glottis may be improved by putting all (ie not only obese) patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult surgical patients who required intubation as part of their routine anaesthesia
排除标准
- •Patients less than 18 years old,
- •Patients recognised to have difficult airways where an alternative method of intubation (e.g. fibre optic) was the method of choice,
- •Patients undergoing emergency surgery where patient positioning and data collection might cause delay (e.g. exsanguinating patients) or where the supine position is not optimal (e.g. brisk bleeding into the upper airway),
- •Patients requiring rapid sequence induction of anaesthesia
结局指标
主要结局
The Best Glottic View Obtained During Laryngoscopy
时间窗: The view of the glottis was measured once while the patient was being intubated
The best glottic view obtained during laryngoscopy was assessed using the Cormack and Lehane classification by the anaesthetist performing the laryngoscopy. The Cormack and Lehane classifies glottic views as follows: Grade 1: Most of the glottis is visible, Grade 2: At best almost half of the glottis is seen, at worst only the posterior tip of the arytenoids is seen., Grade 3: Only the epiglottis is visible, Grade 4: No laryngeal structures are visible.
次要结局
- The Number of Attempts at Both Laryngoscopy and Tracheal Intubation(Once at intubation)
- The Use of Ancillary Equipment(Once at intubation)
- The Time Between the Beginning of Laryngoscopy and Detection of Carbon Dioxide on the End-tidal Carbon Dioxide Monitor(Once at intubation)
研究者
Raj M Reddy
Consultant Anaesthetist
Betsi Cadwaladr University Health Board