Forces on Teeth During Videolaryngoscopy

Catharina Ziekenhuis Eindhoven100 enrolled

Overview

In this randomized crossover trial the investigators test whether three different brands of videolaryngoscopes (VLS) exhibit reduced forces on both upper and lower teeth, and compare them with a classic Macintosh laryngoscope blade.

During endotracheal intubation the anesthesiologist uses a laryngoscope blade to distract the tongue to achieve the best view of the glottis opening, thereby avoiding using the maxillary incisors as a fulcrum to lever the soft tissues upwards. Using the maxillary incisors as a fulcrum may otherwise result in dental trauma. It is obvious that contact with teeth and - even worse - the incidence of accidental dental trauma, is directly related to the difficulty of the intubation. Indirect videolaryngoscopy has proven advantageous over direct laryngoscopy using a classic Macintosh blade, for improved viewing of the glottis, with subsequent more successful intubations, and a shorter effective airway time both in patients with normal and difficult airways. Previously, it has been demonstrated that the forces exerted by the anesthesiologist on the patient's maxillary incisors are reduced when using a VLS, compared with a classic Macintosh laryngoscope. However, only one type of VLS (V-MAC®, Karl Storz, Tuttlingen, Germany) was used or only forces applied to upper teeth were being registered.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

100

Conditions

Tooth Injuries Intubation Complication

Interventions

Forces exerted on teeth during intubationDEVICE

Anesthesia will be induced in the conventional matter. The classic Macintosh laryngoscope will be placed in the patient's mouth and a tube will be brought into position in front of the glottis. Hereafter, one of the three videolaryngoscopes will be placed in the patient's mouth and the endotracheal tube will be actually passed through the vocal cords. The measurement of forces applied to the teeth will be performed using Flexiforce® sensors.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Informed patient consent * ASA I -III * Age \> 18 years * Elective surgery, other than head and/or throat surgery * Pre-operative Mallampati I -III * Fasted (≥6 hours) Exclusion Criteria: * No informed patient consent * ASA ≥ IV * Age \< 18 year * Emergency surgery, surgery of head and/of throat * Locoregional anaesthesia * Pre-operative Mallampati IV * Fasted \< 6 hours * Pre-operative expected difficult airway * No teeth, bad dentition * Dental crowns and/or fixed partial denture

Locations (1)

Catharina Ziekenhuis Eindhoven

Eindhoven, North Brabant, Netherlands

Outcomes

Primary Outcomes

Measuring the frequency with which forces are applied to the upper and lower teeth.

One of the three videolaryngoscopes will be placed in the patient's mouth. The measurement of forces applied to the teeth will be performed using Flexiforce® sensors.

Time frame: At intubation of the patient

Secondary Outcomes

Measuring the magnitude of the forces being applied and registering the differences between (video)laryngoscopes.

Time frame: At intubation of the patient

Data from ClinicalTrials.gov

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