Comparison of Conventional Lightwand Intubation Versus Video-laryngoscope Guided Lightwand Intubation in Simulated Cervical Spine-immobilized Patients

Yonsei University318 enrolled

Overview

Among advanced intubation equipment for difficult intubation, a lighted stylet (lightwand) is a widely used equipment in cervical immobilized patients. However, a lightwand, which is used blind, is difficult to make midline positioning and can increase airway complications and hemodynamic changes. In contrast, videolaryngoscope can view vocal cord indirectly through camera, however, it requires cervical movement. Therefore, investigator hypothesized that the combined use of video-laryngoscope and lightwand for intubation can improve the efficacy of intubation compared to the use of lightwand alone in cervical immobilized patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

318

Conditions

General Anesthesia

Interventions

After anesthetic induction,the difficult airway is simulated by wearing a semi-hard neck collar. For intubation, video-laryngoscope is inserted into the oral cavity ntil the epiglottis tip was visible without lifting the epiglottic vallecula. Then, the endotracheal tube with lightwand is inserted toward the midline under the epiglottis and the intubation is performed looking the transilluminated light of lightwand.

lightwand aloneDEVICE

After anesthetic induction,the difficult airway is simulated by wearing a semi-hard neck collar. Then, the endotracheal tube with lightwand is inserted and the intubation is performed with conventional method (blind technique by confirming transillumination).

Eligibility

Sex: ALLMin age: 20 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. Aged between 20- 80 yrs 2. Patients scheduled surgery under the general anesthesia Exclusion Criteria: 1. Patient who has history of gastro-esophageal reflux disease, previous airway surgery, anatomical abnormality in the upper airway, or coagulopathy 2. Patients with body mass index \>35kg/m2, hemodynamic instability or loosening teeth 3. Patient who disagrees to participate this study or lacks decision-making ability, illiteracy, or foreigner 4. American Society of Anesthesiologists physical status ≥ 3

Outcomes

Primary Outcomes

The success rate of intubation

Confirm the success intubation through end-tidal carbon dioxide on a capnography

Time frame: Within 90 sec after insertion of lightwand or video-laryngosocpe into oral cavity.

The duration of intubation

Define as the duration between insertion of lightwand or video-laryngoscope to oral cavity and removal all intubating devices from oral cavity.

Time frame: Within 90 sec after insertion of lightwand or video-laryngosocpe into oral cavity.

Secondary Outcomes

number of intubation trial and scooping movements

The number of intubation tiral and scooping movements during intubation

Time frame: during intubation time, intubation attempts allows maximum 3 times, within 90 sec in each time

Blood pressure change

The difference between maximum mean blood pressure and minimum blood pressure

Time frame: from start of intubation to 5minute after intubation

Injuries of oral cavity

Check any blood in lips, teeth, endotracheal cuff, and oral cavity

Time frame: at immediate after intubation and extubation

Postoperative hoarseness

Check "Yes or No" through questioning the patient

Time frame: at 1hr after PACU arrival and 24hr after operation

Postoperative sore throat

Check using visual analog scale (0-100 points)