Advertisement

Topics

Comparison of AirTraq Laryngoscope to Macintosh Laryngoscope for Intubation of Patients With Potential Cervical Spine Injury

2014-07-24 14:17:58 | BioPortfolio

Summary

Intubation is frequently required for trauma patients as part of the resuscitative effort. When the stability of the cervical spine is unknown, the potential for spinal cord damage during intubation is significant; the question of the safest intubating technique has not been resolved. Previous Studies have evaluated Macintosh Laryngoscopy, Bullard Laryngoscope, face mask ventilation, fibre-optic guided oral and nasal intubation, esophageal Combitube®, Laryngeal Mask Airway® (LMA), and Intubating Laryngeal Mask Airway® (ILMA) use with respect to cervical spine movement. Our previous study evaluated the Intubating Lighted Stylet (Lightwand®) and GlideScope® versus the Macintosh Laryngoscope.

Another method of securing endotracheal intubation, approved and in routine use, is the AirTraq® videolaryngoscope (ProMedic, Inc, Bonita Springs, FL, USA). The AirTraq videolaryngoscope is a videolaryngoscope with an external video display of the glottic opening and an endotracheal tube track to guide the ETT through the vocal cords (www.airtraq.com). When a clear view of the vocal cords is obtained, the endotracheal tube may be advanced into the trachea. This technique can be performed rapidly and safely and there is the perception that it involves less cervical spine movement than direct laryngoscopy.

We propose to study the AirTraq videolaryngoscope to determine if its use would result in reduced cervical spine movement during intubation.

Description

With the surgeon's consent, informed and written consent will be ob¬tained from patients who are undergoing elective surgery requiring general anesthesia with endotracheal intubation. Preoperative clinical assessment of the patients will include routine airway evaluation of dentition, mouth opening, tongue size, Mallampati score, and neck mobility, as well as height, weight, and age.

While awake, the patients will be placed on the operating room table with a rigid board under their head, neck, and torso in order to simulate the table on which patients involved in trauma are placed in the emergency room. In-line stabilization (ILS), as recommended by the ATLS guidelines, will be applied to maintain the patient's head in the neutral position and reduce neck movement dur¬ing laryngoscopy.

After standard pre-oxygenation, anesthesia will be induced in routine fashion with 2 3 mg/kg propofol and 2-5 mcg/kg fentanyl; rocuro¬nium 0.8 mg/kg will be administered to effect muscle paralysis. The patient will be then be ventilated with 100% O2 via bag/mask for 3 minutes. (Oxygenation with 100% O2 provides an oxygen reservoir for at least 5 minutes while laryngoscopy is completed.) This is the standard of care in anesthesia.

After the patient is anesthetized, a sealed envelope containing computer a generated random assignment will be opened. Laryngoscopy will then be performed two times, with the Macintosh laryngoscope and with the AirTraq videolaryngoscope, in random order as determined by the envelope. Between laryngoscopies, the patient will be ventilated with sevoflurane in 100% oxygen.

Male patients will be intubated with an 8.0 mm inner diameter endotracheal tube (ETT) and women with a 7.0 mm or 7.5 mm ETT at the discretion of the anesthesiologist.

For AirTraq videolaryngoscopy, the AirTraq will be inserted and a view of the vocal cords will be obtained. The ETT will be advanced through the track until the tip of the ETT is visible at the glottic opening and then removed with the AirTraq videolaryngoscope.

For direct Macintosh laryngoscopy, a size 3 laryngoscope blade will be recommended in all patients, but the anesthesiologist may choose another size if deemed necessary. With laryngoscopy, the glottis will be exposed to enable positioning of the endotracheal tube at the vocal cords.

During the second laryngoscopy in the above sequence, the trachea will be intubated. The study is then complete. The hard board will be removed and the surgery will proceed in the usual fashion.

The laryngoscopy and intubation will be recorded by a portable fluoroscopy unit for subsequent review by the radiologist to assess cervical spine movement.

Laryngoscopy time will be defined as the time from when the laryngoscope blade or AirTraq videolaryngoscope passes the teeth of the patient until the time the endotracheal tube is positioned at the opening of the larynx. If the intubation sequence is longer than 120 seconds, it will be deemed a failure and recorded as such.

The Cormack-Lehane score, representing the degree of glottic exposure, of the larynx will be recorded for all patients. Blood oxygen saturation, heart rate, and blood pressure will be recorded every minute during the study.

To minimize inter-operator variability, all bag-mask ventilation, laryngoscopy, and intubation will be completed by one person.

Study Design

Allocation: Randomized, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Conditions

Trauma

Intervention

AirTraq

Location

University of Western Ontario
London
Ontario
Canada
N6A 5A5

Status

Completed

Source

Lawson Health Research Institute

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-07-24T14:17:58-0400

Clinical Trials [333 Associated Clinical Trials listed on BioPortfolio]

Role of Airtraq Mobile to Improve Intubation Conditions With Airtraq

Airtraq sp has been proven effective for intubating patients presenting with difficult airway. The Airtraq sp allows visualisation of the tracheal inlet only for the intubator. By ...

Airtraq Versus Standard Direct Laryngoscopy in the Pediatric Airway

Time to intubate, view to glottic opening and success rate are not different when Airtraq technique is used compared to standard direct laryngoscopy in children.

Intubation in Morbidly Obese: a Comparison of Airtraq and ILMA

bmı > 35 morbidly obese patients requiring endotracheal intubation enrolled in this trial. Divided into two groups Airtraq and ILMA. their effectiveness is evaluated.

Evaluation of Airtraq in Pediatric

This study indented to evaluate the use of Optical laryngoscope in pediatric

Which Nostril Should be Used for Nasotracheal Intubation With Airtraq NT®: the Right or Left? A Randomized Clinical Trial

After Ethics committee approval investigators decided to enroll 40 patients ASA I-II, 18-60 years of age undergoing maxillofascial, oral and double chin surgery to determine which nostril ...

PubMed Articles [1761 Associated PubMed Articles listed on BioPortfolio]

As Trauma Surgeons, Let's Call "Non-Accidental Trauma" What it is: Blunt Force or Penetrating Trauma.

A seven-center examination of the relationship between monthly volume and mortality in trauma: a hypothesis-generating study.

The relationship between trauma volumes and patient outcomes continues to be controversial, with limited data available regarding the effect of month-to-month trauma volume variability on clinical res...

2018 Trauma Association of Canada Presidential Address: ABCs of Trauma: Advocacy Because We Can.

Hidden Burden of Venous Thromboembolism After Trauma: A National Analysis.

Trauma patients are at increased risk for venous thromboembolism (VTE). One in four trauma readmissions occur at a different hospital. There are no national studies measuring readmissions to different...

Tranexamic acid in severe trauma patients managed in a mature trauma care system.

Tranexamic acid (TXA) use in severe trauma remains controversial notably because of concerns of the applicability of the CRASH-2 study findings in mature trauma systems. The aim of our study was to ev...

Medical and Biotech [MESH] Definitions

Specialized hospital facilities which provide diagnostic and therapeutic services for trauma patients.

Damages to the CAROTID ARTERIES caused either by blunt force or penetrating trauma, such as CRANIOCEREBRAL TRAUMA; THORACIC INJURIES; and NECK INJURIES. Damaged carotid arteries can lead to CAROTID ARTERY THROMBOSIS; CAROTID-CAVERNOUS SINUS FISTULA; pseudoaneurysm formation; and INTERNAL CAROTID ARTERY DISSECTION. (From Am J Forensic Med Pathol 1997, 18:251; J Trauma 1994, 37:473)

Systems for assessing, classifying, and coding injuries. These systems are used in medical records, surveillance systems, and state and national registries to aid in the collection and reporting of trauma.

Dysfunction of one or more cranial nerves causally related to a traumatic injury. Penetrating and nonpenetrating CRANIOCEREBRAL TRAUMA; NECK INJURIES; and trauma to the facial region are conditions associated with cranial nerve injuries.

Traumatic injury to the abducens, or sixth, cranial nerve. Injury to this nerve results in lateral rectus muscle weakness or paralysis. The nerve may be damaged by closed or penetrating CRANIOCEREBRAL TRAUMA or by facial trauma involving the orbit.

More From BioPortfolio on "Comparison of AirTraq Laryngoscope to Macintosh Laryngoscope for Intubation of Patients With Potential Cervical Spine Injury"

Advertisement
Quick Search
Advertisement
Advertisement

 

Relevant Topics

Spinal Cord Disorders
The spinal cord is a bundle of nerves that runs down the middle of the back which carry signals back and forth between the body and brain. It is protected by vertebrae, which are the bone disks that make up the spine. An accident that damages the verte...

Anesthesiology
An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. Anesthesiologists are physicians who provide medical care to patients in a wide variety of (usually acute) situations. ...


Searches Linking to this Trial