Macintosh Laryngoscope Assisted Fiberoptic Intubation

Mansoura University

Status: Completed

Conditions: Difficult Intubation

Treatments: Device: fiberoptic, Machintosh; Device: fiberoptic, airway

Study type: Interventional

Funder types: Other

Identifiers

NCT03310866

R/17.08.102

Details and patient eligibility

About

During fiberoptic endotracheal intubation, the perfect airway exposure produced by the classic curved Macintosh laryngoscope in place of head tilt -chin lift-jaw thrust maneuver may increase the accuracy and produce rapid direct vocal cord access in a short time under Inhalation anesthesia to maintain the respiratory drive for grade III&VI Modified Mallampati .

Full description

Managing difficult airway is critical for anesthesia-related morbidity and mortality. Fiberoptic laryngoscope is a reliable tool for endotracheal intubation in difficult airway cases (Modified Mallampatti III&IV), but always there is difficulty to visualize the glottis due to airway tendency to collapse, classically a specific fiberoptic airway with a side way is used and it may added head tilt chin lift jaw thrust. A new technique utilizing sevoflurane anesthesia to maintain the respiratory drive without exposing the patient to the stress of the awake airway instrumentation. Simultaneous utilization of both Macintosh curved laryngoscope and Fiberoptic bronchoscope during Endotracheal intubation (ETT) will be examined for the efficacy during difficult airway management.

All patients should be examined preoperatively for the scoring Modified Mallampati or non tongue protrusion mallampati (NT-MMT) airway score. The pharyngeal structures were then evaluated and the best view (lowest class) was recorded. The classification follows m-MMT and is as follows: class 1, full visibility of tonsils, uvula, and soft palate; class 2, visibility of hard and soft palate, upper portion of tonsils and uvula; class 3, visibility of the soft and hard palate and base of the uvula; and class 4, visibility of only the hard palate, class III or IV patients were included in the study. Inhalational anesthesia use maintains the respiratory drive of the patient allowing less stressful technique.

Enrollment: 100 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult patients with Modified Mallampati (NT-MMT) airway score III,VI
• American Society of Anaesthesiologists (ASA) physical class I-III
• Scheduled for elective cancer surgery under general anesthesia

Exclusion criteria

• Modified Mallampati I,II Airway scored patients.
• History of upper airway surgery.
• Patients with serious deformities of the mandible, maxilla, tongue, pharynx or larynx.
• Patients with a history of significant cardiac and pulmonary diseases,
• Obesity with BMI >40,
• Epilepsy, pregnancy, mental disease, neurological psychological disorders.
• Communication barrier.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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100 participants in 2 patient groups

fiberoptic, airway

Active Comparator group

Description:

Classical fiberoptic intubation assisted by side fenestrated airway and head tilt- chin lift- jaw thrust by 2 anesthetist

Treatment:

Device: fiberoptic, airway

fiberoptic, Machintosh

Experimental group

Description:

oral Fiberoptic bronchoscopic intubation assisted by Macintosh Laryngoscope, by 2 anesthetist

Treatment:

Device: fiberoptic, Machintosh