Videolaryngoscopy-guided intubation has become widespread as a means of preventing major complications relating to airway management by improving the glottic view, increasing the first attempt success rate, likely reduce rates of hypoxemic events, while reducing the rate of airway trauma. However, as randomized controlled studies in patients with anticipated difficult intubation undergoing ear nose and throat (ENT) or oral and maxillofacial (OMF) surgery are lacking, it is still unknown if hyperangulated blades improve glottic view and if their use translates into faster intubation. The primary aim of this randomized controlled trial is to compare the percentage of glottic opening (POGO) between hyperangulated blades and Macintosh blades in patients with expected difficult intubation undergoing ENT or OMF surgery who require transoral tracheal intubation. Secondary aims are to compare secondary outcome measures such as time variables, indicators for difficult and successful intubation, number of attempts, view conditions, difficult airway classifications and adverse events between both blade types.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
182
Intubation using a hyperangulated videolaryngoscope
Intubation using a Macintosh videolaryngoscope
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
Percentage of glottic opening (POGO)
Grading of the best view obtained during laryngoscopy (%)
Time frame: 1 hour
Time to successful tracheal intubation (seconds)
Recorded during airway management
Time frame: 1 hour
Time to successful first attempt intubation (seconds)
Recorded during airway management
Time frame: 1 hour
Cormack-Lehane grade
Grading of the best view obtained during laryngoscopy (I \[best\] to IV \[worst\])
Time frame: 1 hour
Impaired view (vocal cords cannot be visualized by laryngoscopy)
Number of participants with impaired view observed during airway management
Time frame: 1 hour
Difficult laryngoscopy
Number of participants with difficult laryngoscopy as defined in current guidelines
Time frame: 1 hour
Difficult intubation
Number of participants with difficult tracheal intubation as defined in current guidelines
Time frame: 1 hour
Transition to a different tracheal intubation technique
Number of participants in whom the airway operator decided to convert to an alternative intubation technique
Time frame: 1 hour
Tracheal introducer
Number of participants in whom the airway operator decided to use a tracheal introducer
Time frame: 1 hour
Successful first attempt
Number of participants with successful tracheal intubation with only one attempt
Time frame: 1 hour
Overall success of intubation
Number of participants with successful tracheal intubation regardless of the the number of attempts
Time frame: 1 hour
Difficulty of videolaryngoscope-guided intubation
VIDIAC (Videolaryngoscopic Intubation and Difficult Airway Classification) Score from -1 (best) to 5 (worst)
Time frame: 1 hour
Number of intubation attempts
Observed during airway management
Time frame: 1 hour
Number of laryngoscopy attempts
Observed during airway management
Time frame: 1 hour
Airway related adverse events
Number of participants with airway related adverse events observed during airway management
Time frame: 1 hour
Hypoxaemia
Number of participants with a drop in peripheral oxygen saturation during airway management
Time frame: 1 hour
Hypotension
Number of participants with hypotension observed during airway management
Time frame: 1 hour
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.