Optimal Head and Neck Position During Videolaryngoscopy

University Hospitals Coventry and Warwickshire NHS Trust

Status: Completed

Conditions: Head and Neck Position for Intubation

Treatments: Other: C-Mac D-Blade Videolaryngoscope; Other: King Vision Videolaryngoscope

Study type: Interventional

Funder types: Other

Identifiers

NCT02558036

178075

Details and patient eligibility

About

Optimal patient head and neck position when performing videolaryngoscopy for endotracheal intubation has not yet been established.The investigators aim to assess the effect of two different positions on the laryngeal view obtained and success of tracheal intubation during videolaryngoscopy with two commercially available and well established videolaryngoscopes.

Full description

The optimum patient head and neck position for direct laryngoscopy (when the anaesthetist views the larynx with a curved metallic blade before passing a tube for ventilation of the lungs) is traditionally considered to be the "sniffing the morning air" (neck flexion and head extension) position. This has been questioned previously as there is no randomized controlled study to date to explore this statement. The patient should be optimally positioned prior to induction of anaesthesia, especially because in the event of an unexpected difficult intubation, the Difficult Airway Society guidelines suggest the use of an alternative laryngoscope. In current clinical practice a videolaryngoscope (a curved blade with a camera attached to it that allows the anaesthetist to see around corners) has been used as an alternative laryngoscope. To the best of our knowledge, the ideal patient position for videolaryngoscopy has not yet been described. The intubation time and rate of success at intubation using a C-Mac D-Blade videolaryngoscope was previously assessed by Serocki et al, but only in the sniffing position. It is possible that adopting a different position when using the C-Mac D- Blade might result in a superior view of the larynx. Furthermore, the optimal patient position has not yet been assessed for intubation with the King Vision videolaryngoscope.

This key information could gain precious seconds in a difficult airway scenario (when securing the airway with a tube for ventilation proves difficult) and has obvious implications for patient management. The answer to this question could also help the anaesthetists take informed decisions when using videolaryngoscopy to intubate the trachea in elective settings. The investigators aim to assess the effect of two different positions on the laryngeal view obtained during videolaryngoscopy with two commercially available and well established videolaryngoscopes to try and answer this question.

Enrollment: 200 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patients aged 18 and above, presenting for elective surgical procedure and requiring tracheal intubation will be invited to take part in the study.

Exclusion criteria

• Patients who are refusing to take part, below 18 years of age, pregnant women, American society of anaesthesiologists' class 4 and above, those requiring rapid sequence indication, super morbidly obese (BMI >50) and those patients requiring awake fibreoptic intubation will be excluded.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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200 participants in 4 patient groups

C-Mac D-Blade Neutral Position

Active Comparator group

Description:

C-Mac D-Blade videolaryngoscope with patients head and neck in neutral position.

Treatment:

Other: C-Mac D-Blade Videolaryngoscope

Other: C-Mac D-Blade Videolaryngoscope

C-Mac D-Blade Sniffing Position

Active Comparator group

Description:

C-Mac D-Blade videolaryngoscope with patients head and neck in sniffing position.

Treatment:

Other: C-Mac D-Blade Videolaryngoscope

Other: C-Mac D-Blade Videolaryngoscope

King Vision Neutral Position

Active Comparator group

Description:

King Vision videolaryngoscope with patients head and neck in neutral position.

Treatment:

Other: King Vision Videolaryngoscope

Other: King Vision Videolaryngoscope

King Vision Sniffing Position

Active Comparator group

Description:

King Vision videolaryngoscope with patients head and neck in sniffing position.

Treatment:

Other: King Vision Videolaryngoscope

Other: King Vision Videolaryngoscope