scholarly journals Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial

2020 ◽  
Vol 9 (3) ◽  
pp. 671
Author(s):  
RyungA Kang ◽  
Ji Seon Jeong ◽  
Justin Sangwook Ko ◽  
Jaemyung Ahn ◽  
Mi Sook Gwak ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Head Position ◽  
Neutral Position ◽  
Dental Surgery ◽  
Intubation Difficulty ◽  
Difficulty Scale ◽  
Nasotracheal Tube ◽  
Glidescope Video Laryngoscope ◽  
Position Group

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

scholarly journals Appropriate Head Position for Nasotracheal Intubation by Using Lightwand Device (Trachlight)

2014 ◽  
Vol 61 (2) ◽  
pp. 47-52
Author(s):  
Yozo Manabe ◽  
Shigeru Iwamoto ◽  
Mika Seto ◽  
Kazuna Sugiyama
Keyword(s):  
Nasotracheal Intubation ◽  
Head Position ◽  
Ordinal Scale ◽  
Neutral Position ◽  
Intubation Time ◽  
Point Scale ◽  
Intubation Difficulty ◽  
Significant Difference ◽  
The Relationship ◽  
Position Group

Abstract The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of “unsuccessful” cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis.

scholarly journals Effect of neck extension on the advancement of tracheal tubes from the nasal cavity to the oropharynx in nasotracheal intubation: a randomized controlled trial

2019 ◽  
Author(s):  
Hyerim Kim ◽  
Jung-Man Lee ◽  
Jiwon Lee ◽  
Jin-Young Hwang ◽  
Jee-Eun Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nasal Cavity ◽  
Success Rate ◽  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Neutral Position ◽  
Neck Extension ◽  
Randomized Controlled ◽  
Extension Group ◽  
Position Group

Abstract Background Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation. Methods Patients were randomized to the ‘neck extension group (E group)’ or ‘neutral position group (N group)’ for this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the E group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patient’s neck extended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was successfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned group, the case was defined as to ‘success.’ We compared the success rate of tube advancement between the two groups. Results Thirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube passage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%; odds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002). Conclusion Neck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.

scholarly journals Effect of neck extension on the advancement of tracheal tubes from the nasal cavity to the oropharynx in nasotracheal intubation: a randomized controlled trial

2019 ◽  
Author(s):  
Hyerim Kim ◽  
Jung-Man Lee ◽  
Jiwon Lee ◽  
Jin-Young Hwang ◽  
Jee-Eun Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nasal Cavity ◽  
Success Rate ◽  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Neutral Position ◽  
Neck Extension ◽  
Randomized Controlled ◽  
Extension Group ◽  
Position Group

Abstract Background Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation. Methods Patients were randomized to the ‘neck extension group (E group)’ or ‘neutral position group (N group)’ for this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the E group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patient’s neck extended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was successfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned group, the case was defined as to ‘success.’ We compared the success rate of tube advancement between the two groups. Results Thirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube passage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%; odds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002). Conclusion Neck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.

scholarly journals Effect of neck extension on the advancement of tracheal tubes from the nasal cavity to the oropharynx in nasotracheal intubation: a randomized controlled trial

2019 ◽  
Author(s):  
Hyerim Kim ◽  
Jung-Man Lee ◽  
Jiwon Lee ◽  
Jin-Young Hwang ◽  
Jee-Eun Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nasal Cavity ◽  
Success Rate ◽  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Neutral Position ◽  
Neck Extension ◽  
Randomized Controlled ◽  
Extension Group ◽  
Position Group

Abstract Background Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation. Methods Patients were randomized to the ‘neck extension group (E group)’ or ‘neutral position group (N group)’ for this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the E group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patient’s neck extended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was successfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned group, the case was defined as to ‘success.’ We compared the success rate of tube advancement between the two groups. Results Thirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube passage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%; odds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002). Conclusion Neck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.

scholarly journals Effect of neck extension on the advancement of tracheal tubes from the nasal cavity to the oropharynx in nasotracheal intubation: a randomized controlled trial

2019 ◽  
Author(s):  
Hyerim Kim ◽  
Jung-Man Lee ◽  
Jiwon Lee ◽  
Jin-Young Hwang ◽  
Jee-Eun Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nasal Cavity ◽  
Success Rate ◽  
Controlled Trial ◽  
Nasotracheal Intubation ◽  
Neutral Position ◽  
Neck Extension ◽  
Randomized Controlled ◽  
Extension Group ◽  
Position Group

Abstract Background Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril, from the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to investigate the effect of neck extension on advancement of tracheal tubes from the nasal cavity into the oropharynx during nasotracheal intubation. Methods Patients were randomized to the ‘neck extension group (E group)’ or ‘neutral position group (N group)’ for this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the E group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patient’s neck extended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was successfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned group, the case was defined as to ‘success.’ We compared the success rate of tube advancement between the two groups. Results Thirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube passage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%; odds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002). Conclusion Neck extension during tube advancement from the nasal cavity to the oropharynx before laryngoscopy could be helpful in nasotracheal intubation.

scholarly journals Comparison of McGrath Videolaryngoscope and Macintosh Laryngoscope in Children with Torticollis: Randomized Controlled Trial

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1171
Author(s):  
Min Hur ◽  
Jong Yeop Kim ◽  
Sang Kee Min ◽  
Kyuheok Lee ◽  
Young Ju Won ◽  
...  
Keyword(s):  
Success Rate ◽  
Controlled Trial ◽  
Macintosh Laryngoscope ◽  
Orotracheal Intubation ◽  
Difficulty Level ◽  
Intubation Time ◽  
Intubation Difficulty ◽  
Lifting Force ◽  
Lehane Grade ◽  
Difficulty Scale

We investigated the efficacy of the McGrath videolaryngoscope compared with the Macintosh laryngoscope in children with torticollis. Thirty children aged 1–10 years who underwent surgical release of torticollis were randomly assigned into the McGrath and Macintosh groups. Orotracheal intubation was performed by a skilled anesthesiologist. The primary outcome was the intubation time. The Cormack–Lehane grade, lifting force, intubation difficulty scale (IDS), difficulty level, and intubation failure rate were also assessed. The intubation time was significantly longer in the McGrath group than in the Macintosh group (31.4 ± 6.7 s vs. 26.1 ± 5.4 s, p = 0.025). Additionally, the Cormack–Lehane grades were comparable between the groups (p = 0.101). The lifting force and IDS were significantly lower in the McGrath group than in the Macintosh group (p < 0.001 and p = 0.022, respectively). No significant differences were observed with respect to endotracheal intubation difficulty and intubation success rate. Intubation-related complications were also not observed. In conclusion, compared with the Macintosh laryngoscope, the McGrath videolaryngoscope extended the intubation time and did not improve glottic visualization in children with torticollis, despite having a lesser lifting force, lower intubation difficulty scale, and similar success rate.

scholarly journals Time to intubation with McGrath™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial

2021 ◽  
Author(s):  
QY Goh ◽  
SA Lie ◽  
Z Tan ◽  
PYB Tan ◽  
SY Ng ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Surgical Patients ◽  
Intubation Difficulty ◽  
Direct Laryngoscope ◽  
Significant Difference ◽  
Scale Scores ◽  
Difficulty Scale ◽  
Randomised Controlled

Introduction: During the COVID-19 pandemic, multiple guidelines have recommended the videolaryngoscope for tracheal intubation. However, there is no evidence that videolaryngoscope reduces time to tracheal intubation, which is important for COVID-19 patients with respiratory failure. Methods: To simulate intubation of COVID-19 patients, we randomised 28 elective surgical patients to be intubated with either the McGrath™ MAC videolaryngoscope or the direct laryngoscope by specialist anaesthetists donning 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. Primary outcome was time to intubation. Results: The median (IQR) times to intubation were 61s (37–63 s) and 41.5s (37–56 s) in the videolaryngoscope and direct laryngoscope groups respectively (p = 0.35). The closest mean (SD) distances between the anaesthetist and the patient during intubation were 21.6 cm (4.8 cm) and 17.6 cm (5.3 cm) in the videolaryngoscope and direct laryngoscope groups, respectively (p = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubation at first laryngoscopic attempt and proportion of intubations requiring adjuncts. Intubations for all the patients were successful with no adverse event. Conclusion: There was no significant difference in the time to intubation by specialist anaesthetists who were donned in PAPR and N95 masks on elective surgical patients with either the McGrath™ videolaryngoscope or direct laryngoscope. The distance between the anaesthetist and patient was significantly further with the videolaryngoscope. The direct laryngoscope could be an equal alternative to videolaryngoscope for specialist anaesthetists when resources are limited or disrupted due to the pandemic.

scholarly journals Effects of Head Positions on Awake Orotracheal Intubation Via Fiberoptic-Bronchoscope: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Zhuo Liu ◽  
Li Zhao ◽  
Meiqi Liu ◽  
Xiaohang Qi ◽  
Qianqian Jia ◽  
...  
Keyword(s):  
Tracheal Tube ◽  
Orotracheal Intubation ◽  
Head Position ◽  
Neutral Position ◽  
Fiberoptic Bronchoscope ◽  
Glottic Opening ◽  
Vocal Cords ◽  
Vas Scores ◽  
Head Positions ◽  
Position Group

Abstract Background: There are many factors affect the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study to investigate the effects and safety of three head positions on awake orotracheal intubation via fiberoptic bronchoscope. Methods: Seventy-five adult patients with anticipated difficult airway, received general anaesthesia and undergoing awake orotracheal intubation were included in this study. According to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After conscious sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the time to insert the tracheal tube into the trachea, the percentage of glottic opening scores (POGO) and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through the glottis, the hemodynamic changes during intubation and the adverse events after surgery were recorded. Results: The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P<0.05); the SpO2 immediate after intubation was higher in the EP group compared with SP group (P<0.05) and the SpO2 before intubation was higher in the EP group compared with NP group (P<0.05), while at other time points the SpO2 had no significant difference among groups. The time to tracheal intubation, the VAS scores for passing the tracheal tube through glottis, the coughing scores of patients when inserted fiberoptic bronchoscope into the trachea and inserted the tracheal tube into the trachea over fiberoptic bronchoscope had no significant differences among groups (P>0.05). There were also no significant differences among the groups with regard to the incidence of postoperative complications, mean arterial pressure and heart rate at each time point (P>0.05). Conclusions: Extension position had a best view of glottic opening than neutral position or sniffing position during awake orotracheal intubation via fiberoptic bronchoscope, so extension position was recommended as the starting head position for awake orotracheal intubation using fiberoptic bronchoscope.Trial registration: Clinical Trials.gov. no. NCT 02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

scholarly journals Is there an optimal place to hold the endotracheal tube during direct laryngoscopy for patients undergoing surgery under general anesthesia? Protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Manisha Sahoo ◽  
Swagata Tripathy ◽  
Nitasha Mishra
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Controlled Trial ◽  
Scientific Evidence ◽  
Optimal Size ◽  
Significance Level ◽  
Intubation Difficulty ◽  
Difficulty Scale ◽  
Group 2

Abstract Background Endotracheal intubation by direct laryngoscopy is a widely performed lifesaving technique. Although there are guidelines for optimal size and depth of insertion of an endotracheal tube (ETT) for successful intubation, there is no consensus on the point at which it should be held along its length. This will arguably affect the time, ease, and success of the technique due to a difference in visualization and torque applied to the ETT after glottic visualization. We aim to compare the effect of 2 different sites of holding the ETT on time to intubation (TTI), intubation difficulty scale (IDS), and complications. Methods ASA 1–2 patients (>18 years) posted for surgery under general anesthesia, undergoing supervised intubation by anesthesia trainees (experience < 18 months), will be included. Patients with an anticipated difficult airway or unanticipated difficulty—CL grade 3 or 4 requiring the use of airway adjuncts—will be excluded. Patients will be randomized by a computer-generated number list, and allocation concealed with opaque sealed envelopes. The two sites for holding the ETT will be group 1 at 19 cm and group 2 at 24 cm. ETT marked at the selected site will be handed by the technician once the optimum position of the table, patient, and laryngoscopic view is confirmed by the intubator. The entire procedure will be video recorded. Two blinded assessors will independently review the videos to document the time to intubation and intubation difficulty score. A postoperative sore throat will be recorded. Sample size To detect a 20% difference in time to intubation between groups with a significance level of 5% and power of 85%, we will need a total of 298 patients. Accounting for data loss, we plan to recruit 180 patients in each group. Discussion This will be the first study to assess whether the site of holding the tube has any impact on the ease and time taken for intubation. The findings of this study will provide scientific evidence for suggesting an appropriate place for holding the ETT during direct laryngoscopy procedures. Trial registration Clinical Trials Registry India CTRI/2019/09/021201

Sign in / Sign up

Export Citation Format

Share Document