Forces on Teeth During Videolaryngoscopy

Catharina Hospital

Status: Completed

Conditions: Tooth Injuries; Intubation Complication

Treatments: Device: Forces exerted on teeth during intubation

Study type: Interventional

Funder types: Other

Identifiers

NCT01599312

NL39915.060.12

M12-1217 (Other Identifier)

Details and patient eligibility

About

In this randomized crossover trial the investigators test whether three different brands of videolaryngoscopes (VLS) exhibit reduced forces on both upper and lower teeth, and compare them with a classic Macintosh laryngoscope blade.

Full description

During endotracheal intubation the anesthesiologist uses a laryngoscope blade to distract the tongue to achieve the best view of the glottis opening, thereby avoiding using the maxillary incisors as a fulcrum to lever the soft tissues upwards. Using the maxillary incisors as a fulcrum may otherwise result in dental trauma. It is obvious that contact with teeth and - even worse - the incidence of accidental dental trauma, is directly related to the difficulty of the intubation.

Indirect videolaryngoscopy has proven advantageous over direct laryngoscopy using a classic Macintosh blade, for improved viewing of the glottis, with subsequent more successful intubations, and a shorter effective airway time both in patients with normal and difficult airways. Previously, it has been demonstrated that the forces exerted by the anesthesiologist on the patient's maxillary incisors are reduced when using a VLS, compared with a classic Macintosh laryngoscope. However, only one type of VLS (V-MAC®, Karl Storz, Tuttlingen, Germany) was used or only forces applied to upper teeth were being registered.

Enrollment: 100 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Informed patient consent
• ASA I -III
• Age > 18 years
• Elective surgery, other than head and/or throat surgery
• Pre-operative Mallampati I -III
• Fasted (≥6 hours)

Exclusion criteria

• No informed patient consent
• ASA ≥ IV
• Age < 18 year
• Emergency surgery, surgery of head and/of throat
• Locoregional anaesthesia
• Pre-operative Mallampati IV
• Fasted < 6 hours
• Pre-operative expected difficult airway
• No teeth, bad dentition
• Dental crowns and/or fixed partial denture

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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100 participants in 4 patient groups

Classic Macintosh laryngoscope

Other group

Description:

Classic Macintosh laryngoscope (Karl Storz, Tuttlingen, Germany)

Treatment:

Device: Forces exerted on teeth during intubation

McGrath®

Other group

Description:

McGrath® (Aircraft Medical Ltd, Edinburgh, UK)

Treatment:

Device: Forces exerted on teeth during intubation

C-MAC®

Other group

Description:

C-MAC® (Karl Storz, Tuttlingen, Germany)

Treatment:

Device: Forces exerted on teeth during intubation

GlideScope® Cobalt

Other group

Description:

GlideScope® Cobalt (Verathon Medical, Bothell, WA, USA)

Treatment:

Device: Forces exerted on teeth during intubation