This study will include pregnants who preferred to undergo general anesthesia for elective cesarean section. Ramped and sniffing positions of pregnant women during ventilation and intubation will be compared. The aim of this study is to investigate which position provides easier and faster intubation in pregnant women for cesarean section.
Estimates of the frequency of difficult and failed intubation in the obstetric population vary within a wide range of percentiles. Several times higher than those reported for the general surgery population. Functional Residual Capacity decreases by 10% - 25% in Pregnant women. Pregnant women are more susceptible to hypoxia as a result of this decline, which also encourages intubation to occur more rapidly. Intubation success and shortening of intubation time have improved positively with videolaryngoscopes. On the other hand, the position of the patient during intubation contributes to the speed and success of intubation. It has been shown that intubation is faster and first-pass success is higher in the ramped position in morbidly obese patients.This study will compare the effectiveness of ramp and sniffing positions on intubation time and success in obese patients and pregnant women with similar physical changes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
This position will be achieved by elevation of the shoulders and the head elevation till achieving alignment of sternal notch and external auditory meatus
This position will be achieved by placing a 7 cm pillow under the occiput.
Karaman Training and Research Hospital
Karaman, Turkey (Türkiye)
1. Total intubation time
Total intubation time will be calculated by adding up the laryngoscopy time and tube insertion time.
Time frame: 5 minutes after induction of general anesthesia
Incidence of difficult intubation
The Intubation Difficulty Scale (IDS) will be used to define the intubation difficulty. Intubation is considered easy if IDS=0, slight difficulty if 0 \< IDS \< 5, Moderate to Major Difficulty if 5 \< IDS, impossible if IDS = ∞.
Time frame: 5 minutes after induction of general anesthesia
Incidence of difficult mask ventilation
The Warters Scale will be used to define the mask ventilation difficulty. Difficult mask ventilation is defined as a score ≥ 4 on the Warters scale
Time frame: 5 minutes after induction of general anesthesia
Laryngoscopy time
The timing measurements will begin when the videolaryngoscope blade first passes between the teeth and will end when the best glottic view is obtained on the videolaryngoscopy monitor.
Time frame: 5 minutes after induction of general anesthesia
Tube insertion time
The timing measurements will begin when the endotracheal tube first passes between the teeth and ended when the tube passes through the glottis.
Time frame: 5 minutes after induction of general anesthesia
Complications related to intubation
A postoperative follow-up assessment will be performed approximately 4 hr after surgery by a co-investigator blinded to the intubation position to evaluate the presence and severity of sore throat, any changes in voice, trauma to the lip, tongue, palate, or teeth.
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Time frame: postoperative 4th hour