Comparison of Intubating Conditions in 25° Head-up Position and Strict Supine

University Hospital, Clermont-Ferrand1,000 enrolled

Overview

Tracheal intubation, particularly before surgery, is traditionally done in supine position. It was shown in the general population and in obese patients in particular, that the pre-oxygenation in a 25° head-up position provided a better efficiency of the pre-oxygenation and an apnea time longer. This position would also allow for better intubation conditions in direct laryngoscopy. The investigators intend to assess two different patient's intubation position : supine position and 25° head-up position

Randomization assigned in random block, stratification by operator (20 patients per operator, 10 in each group). Interim analysis every 100 patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

1,000

Conditions

Intubation Intratracheal

Interventions

Intubation positionPROCEDURE

The investigators assess two different patient's intubation position : supine position and 25° head-up position looking at the intubation score (POGO score).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * \- patients scheduled for various surgeries requiring general anesthesia with curare, with intubation of the trachea, eligible for intubation by direct laryngoscopy. * \> 18 years * patients with social security Exclusion Criteria: * Emergency surgery. * Patient who requiring rapid sequence induction. * Intubation without curare. * Expected difficult intubation with planned modification of the intubation protocol (i. e. intubation under fibroscopy, airtrach or videolaryngoscopy) * Patient with a history of epilepsy, pulmonary or cardiovascular disease (including ischemic heart disease, symptomatic asthma or obstructive pulmonary disease). * Patient with mask phobia. * BMI\> 30kg / m2 * Patient who are refusing to take part. * Patient protected major, minor, pregnant women, patients deemed incapable of giving informed consent.

Locations (6)

CHU Clermont-Ferrand

Clermont-Ferrand, France

Pôle Santé République

Clermont-Ferrand, France

Centre Hospitalier Alpes-Léman

Contamine-sur-Arve, France

Polyclinique Saint Odilon

Moulins, France

Outcomes

Primary Outcomes

POGO score

valid score observed by the anesthetist performing intubation at the time of intubation. POGO score means Percentage of Glottic Opening : from 0% (none visualization of the glottic opening, worst result) to 100% (complete visualization of the glottic opening, best result), from the anterior curvature of the vocal cords to the interarytenoid node, between the posterior cartilage

Time frame: at day 1

Secondary Outcomes

Cormack-Lehane grade

another valid score observed by the anesthetist performing intubation at the time of intubation. It classifies views obtained by direct laryngoscopy based on the structures seen. From 1 (best result) to 4 (worst result). 1 : full view of glottis (POGO 100%) / 2 : partial view of glottis / 3 : only epiglottis seen, none of glottis seen (POGO 0%) / 4 : Neither glottis nor epiglottis seen (POGO 0%).

Time frame: at day 1

Intubation operator's comfort

visual analog scale about the operator's comfort during intubation. It's a subjective score. It's an evaluation of the comfort of the intubation position from 0 to 10, where 0 is a total discomfort, a painful, very uncomfortable position and 10 is an optimal, very comfortable position.

Time frame: at day 1

Episodes of desaturation and episodes of hypotension

SpO2 \<90% or MAP \<65mmHg or drop\> 20% of the patient's baseline SBP

Time frame: at ady 1

Mechanical complications of intubation:

laryngeal pain, hoarseness, upper airway trauma

Time frame: at day 1

Patient height

at the tragus of the ear during intubation.

Time frame: at day 1

Data from ClinicalTrials.gov

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