Retrograde Light Target Tracheal Intubation Technique:Clinical Comparison With Direct Pharyngoscopic Tracheal Intubation
Condition: Tracheal Intubation Morbidity
Study type: Interventional

Summary: 
      The investigators hypothesise that, for novices, light guided tracheal intubation will
      improve the time and success rate of this clinical skill compared to standard direct tracheal
      intubation.
    

Detailed description: 
      The experiment was conducted under the close supervision of the coaching anesthesiologists in
      several stages.

      The training stage: First of all, the operators received training with respect to the
      theories and principles of airway management, including techniques of bag-mask ventilation,
      Direct laryngoscopy and tracheal intubation and light-guided and tracheal intubation until
      they had a good master about the theoretical background, technical risks and indications of
      the two techniques. Then, they had to receive manikin training of the two techniques on the
      Airway Management Trainer. Exposure of the glottis(EG)/tracheal intubation(TI) training would
      be continued before they were able to use both techniques to complete three consecutive cases
      of Exposure of the glottis/tracheal intubation operation successfully on the manikin trainer
      within 120 seconds (s) at a time.

      20 medical workers were assigned to perform TI within 120s with either Direct laryngoscopy TI
      or light-guided TI technique, which was selected randomly and then converted to the
      alternative one until they complete 5 cases with each of the two techniques. The time of EG
      started from mouth opening of the patient to the exposure of the glottis. The time of TI also
      started from mouth opening of the patient to the completion of inserting the tracheal guide
      to the tracheal and sealing it with cuff inflation. The EG time, Cormack-Lehane (C&L) grades,
      TI time, one-time success rate, and the overall success rate in using the two TI techniques
      were recorded.

      The patient was laid in a supine position, with the head laid on a 7cm-high pillow for the
      sake of stability. The peripheral vein was accessed routinely and connected to a standard
      monitor for electrocardiography (ECG), SpO2 and noninvasive blood pressure (BP). Sufficient
      oxygen inhalation was initiated for > 3min before induction of general anesthesia with
      midazolam, propofol, fentanyl and rocuronium bromide. The anesthesiologist was not allowed to
      give any instruction and suggestion or assistance to the operator during the whole process.
      The coaching anesthesiologist supervised the whole TI process closely. Should any hidden risk
      occur or the TI exceed the required time of the experiment, the TI attempt of the operator
      would be terminated and replaced by the anesthesiologist in order to ensure patients' safety:
      TI exceeded 120s; Attempt of TI exceeded 2 times; SpO2 decreasing to below 95%; appearance of
      unstable hemodynamic situations (mean BP or HR fluctuating by more than 25% of the baseline
      value); or occurrence of airway injury as evidenced by stained blood on the Macintosh Blade.
      Any patient with C&L grade III~IV as discovered by the anesthesiologist during TI would be
      excluded from the present study and replaced by anther patient to re-start the experiment. A
      7.0- or 7.5-mm-ID endotracheal tube was used as the guide according to the patient's
      condition.
    

Intervention name(s): light guided tracheal intubation
Intervention type(s): Procedure
Intervention description(s): Tracheal intubation light guided technique.
Other intervention name(s): intubation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research