Tracheal Tube Cuff Inflation-Deflation Method for Video Assisted Laryngoscope Nasal Intubation in Adults

Study Overview
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Brief Summary
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Magill forceps is used to maneuver the endotracheal tube ETT in the posterior oropharynx and place its tip into the laryngeal inlet. While the Magill forceps are useful in guiding the nasotracheal tube past the vocal cords, care must be taken to avoid excessive maneuvering in order to minimize the risk of local trauma and rupture of the nasotracheal tube balloon. Cuff inflation-deflation method can reduce the apnea time in the adult patients. This, in turn, could point to a reduction in the complications (as desaturation and cardiac arrhythmia) that associated with the prolonged-time procedure.

Official Title
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Tracheal Tube Cuff Inflation-Deflation Method for Video Assisted Laryngoscope Nasal Intubation in Adults

Conditions
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Airway Management

Intervention / Treatment
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* Procedure: Tracheal Intubation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists (ASA) physical status I-III Scheduled for elective surgery (dental and maxillofacial) in need for nasal intubation. Exclusion Criteria: Patients, who have coagulopathies, Have upper airway abnormalities, At risk for aspiration or by reasons of Parent's refusal will be excluded from the study

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Inflation-Deflation Group<br> | Procedure: Tracheal Intubation<br>* Inflation-Deflation Technique Versus Magill Forceps Technique for Nasal Intubation by Video-assisted Laryngoscope<br>|
| Active Comparator: Magill Forceps Group<br> | Procedure: Tracheal Intubation<br>* Inflation-Deflation Technique Versus Magill Forceps Technique for Nasal Intubation by Video-assisted Laryngoscope<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| to test whether the inflation-deflation method would decrease the need for Magill forceps in video laryngoscopy assisted nasal intubation in pediatric patients compared with the conventional non-cuff inflation approach. | The percentage of patients who did not require Magill forceps for nasal intubation success was recorded. | 60 seconds | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The time period for the second phase nasal intubation | The time in seconds for the second phase nasal intubation(from the tip of endotracheal tube will be placed in pharynx till it pass the vocal cords | 60 seconds | 
| The number of attempts required for successful nasal intubation. | number of trials, how many numbers of attempts the investigator take for successful nasal intubation | 120 seconds | 
| Amount of injected air for cuff inflation | Amount of injected air in ml, how many air injected in the cuff balloon to make the tip of endotracheal tube advanced into the trachea | 15 seconds | 
| Assessment of side effects of using Magill forceps during nasal intubation | A 4-point scale: 1- No epistaxis; 2-Mild epistaxis (blood on the tracheal tube only); 3- Moderate epistaxis (blood pooling in the pharynx); 4- Severe epistaxis (blood in the pharynx sufficient to impede intubation) | 48 hours | 
| Evaluation of oxygenation state during nasal intubation | rate of oxygen drop during the procedure | preoperative and intraoperative | 
| evaluate the anesthetists' experience of using the inflation-deflation method for nasal intubation. | score 1 to 5 A five-point Likert scales for: How likely is it that anesthetist would recommend the same used inflation-deflation method to practice a colleague in the future (not at all/ slightly/ moderately/ very/ extremely: where 1 is not at all, 3 is moderate,5 is extremely | 20 minutes after patient recovery | 
| Need for external compression and need for help | Need for external tracheal compression and need for help | 60 minutes | 
| need of endotracheal tube rotation | need of endotracheal tube rotation and the degree of rotation 90, 180 0r 360 degree | 60 seconds | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nasal intubation, Video-assisted Laryngoscope