Comparison Between Rigid Video Assisted Laryngoscopy vs Flexible Laryngoscopy in Anticipated Difficult Intubation
Condition: Intubation
Study type: Interventional

Summary: 
      This is a randomized control study where adult patients had been divided randomly into two
      equal groups using video laryngoscope in group (V) and flexible intubating laryngoscope in
      group (F)
    

Detailed description: 
      Routine pre-operative assessment including history taking, clinical examination, and
      laboratory tests. Patients were admitted to the operating room with a small 20G IV cannula
      after applying inclusion & exclusion criteria and airway assessment by applying El Ganzuri
      multivariate risk index for difficult intubation which include assessment of the following :
      inter-incisor gap, Mallampati classification, head &neck movement, buck teeth prognathism,
      thyromental distance, body weight and history of difficult intubation.

      Operating room was prepared using :

      Difficult airway cart that includes different size oral airways, endotracheal tubes,
      different sizes face masks & laryngeal airway masks Suction apparatus to be ready for use
      Video laryngoscopy The flexible intubating laryngoscopy with the tube mounted over the
      fiberscope before the procedure.

      Standard monitoring devices were applied including ECG, non invasive blood pressure. pulse
      oximetry and capnography after intubation Patients were then pre-oxygenated via face mask for
      three minutes and using 0.01 mic/kg atropine then general anesthesia is induced using
      fentanyl 1-2 mic/kg followed by propofol 2 mg/kg and esmeron 0.5 mg/kg.

      The patient is mechanically ventilated using face mask until full relaxation is established
      after 3-5 minutes. The intubation is done using video laryngoscope in group (v) or using
      flexible intubating laryngoscopy in group (f) In the first group (v) The video laryngoscope
      was introduced with the patient appropriately positioned, the operator used the left hand to
      introduce the video laryngoscope into the midline of the Oropharynx and gently advances until
      the blade tip pass the posterior portion of the tongue. Using video visualization, the ETT
      was then advanced on a smooth curve through the glottis and intubation proceeds. Viewing the
      entire insertion step on the video screen allows the operator to quickly become facile with
      the motion of gently rotating or angling the tube using the right hand to redirect as
      necessary.

      In the second group(f) patients positioned supine with the operator standing at the head of
      the bed. Simple chin lift and jaw thrust may improve the view through the flexible
      laryngoscopy and also help to prevent airway obstruction. The endotracheal tube should be
      lubricant to facilitate its subsequent advancement into the trachea. Once the endotracheal
      tube is in place, the scope is removed, and the patient is ventilated. Flexible intubating
      laryngoscopy is often performed with the operator looking through the eyepiece. However,
      connecting the flexible laryngoscopy to a monitor is often advantageous.

      After collecting demographic data of the patient (age, sex, body mass index & ASA) The
      following parameters will be measured :

      Intubation time, Hemodynamic parameters, success rate and number of attempts & incidence of
      complications.
    

Intervention name(s): Video laryngoscopy; Flexible intubating laryngoscopy
Intervention type(s): Device; Device
Intervention description(s): Endotracheal intubation using video laryngoscopy; Endotracheal intubation using flexible intubating laryngoscope
Other intervention name(s): Storz c-mac laryngoscopy; Storz flexible intubation video endoscope set
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: two equal groups; group (V) using video laryngoscope(53) and group (F) using flexible intubating laryngoscopy(53).
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: video laryngoscopy; Flexible intubating bronchoscope; Anticipated difficult intubation