Comparative Evaluation of Three Airway Maneuvers in the Unconscious Apneic Person

Tri-Service General Hospital

Status: Unknown

Conditions: Airway Morbidity

Treatments: Procedure: airway maneuver

Study type: Interventional

Funder types: Other

Identifiers

NCT02104453

WChan (Registry Identifier)

1-103-05-029

Details and patient eligibility

About

One-handed E-C clamp mask holding technique, two-handed mask ventilation with jaw thrust, and two-handed mask ventilation with triple airway maneuver are three common airway management maneuvers. Sniffing position may improve ventilation between these three maneuvers. The investigators hypothesize that ventilation efficiency may be different between these three maneuvers whether the patient is in sniffing position or neutral position. The investigators would like to quantify this effect by measuring the expired tidal volume, airway pressure, EtCO2 slope and hemodynamic change between these three maneuvers during anesthesia induction.

Full description

Mask ventilation is considered a important skill for airway management during general anesthesia induction and for apneic unconscious patients. One-handed E-C clamp mask holding technique, two-handed mask ventilation with jaw thrust, and two-handed mask ventilation with triple airway maneuver are three common airway management maneuvers. However, the efficiency of ventilation between these three maneuvers has to be clarified. Besides, whether sniffing position or neutral position may improve ventilation between these three maneuvers is to be determined. The investigators will collect airway parameters of the patients receiving general anesthesia and measure the expired tidal volume, airway pressure, EtCO2 slope and hemodynamic change between these three maneuvers during anesthesia induction.

Enrollment: 120 estimated patients

Sex: All

Ages: 20 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• adult patients(ASA I-III) scheduled for elective surgery requiring general anesthesia with endotracheal intubation.

Exclusion criteria

• pneumothorax
• SpO2<96%(without additional oxygen supply)
• vocal cord palsy
• congenital airway abnormality
• facial trauma or deformity
• acute upper airway disease
• inadequate fasting time
• neck or potential cervical spine disease
• temporal-mandible joint abnormality
• head and neck tumor
• status post radiotherapy
• pregnancy
• long term sedative or opioid drug use
• patient refuse

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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120 participants in 3 patient groups

E-C clamp mask holding technique

Experimental group

Description:

the airway maneuver that press the mask against the patient's face (using the "C" of our thumb and forefinger) while pulling the jaw forward (using the "E" of our other fingers behind the mandible), and leaves one hand free to squeeze the bag.

Treatment:

Procedure: airway maneuver

two-handed ventilation with jaw thrust

Experimental group

Description:

the airway maneuver performed with thumbs point toward feet, palms press down and other fingers perform jaw thrust

Treatment:

Procedure: airway maneuver

triple airway maneuver

Experimental group

Description:

the airway maneuver performed with two-handed mask ventilation, jaw thrust and head-tilt chin-lift technique

Treatment:

Procedure: airway maneuver