Comparing the snifﬁng Position , Simple Head Extension and Neutral Position

Study Overview
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Brief Summary
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The simple head extension is recommended for optimization of glottic visualization during awake orotracheal intubation whith fiberoptic bronchoscope (FOB) . However, no study to date has conﬁrmed its superiority over snifﬁng position . In a prospective, randomized study, the authors compared the snifﬁng position , simple head extension and Neutral Position in awake orotracheal Intubation.

Detailed Description
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The study included seventy-five patients with anticipated difficult airways. The snifﬁng position was obtained by placement of a 7-cm cushion under the head of the patient. The extension head position was obtained by by placement of a 7-cm cushion under the shoulder. The head position was randomized as follows: neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group) Randomization was performed by placing index cards with the letter NP or SP or EP into75 sealed envelopes , which were then placed in random order. At the time of a patient's enrollment, the next available envelope was placed with the patient's chart. At the time of intubation, the envelope was opened and the sequence was thus determined.

Official Title
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Randomized Study Comparing the snifﬁng Position , Simple Head Extension and Neutral Position for Awake Orotracheal Intubation With Fiberoptic in Anticipate Difficult Airway Patients

Conditions
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Therapeutic Procedural Complication

Intervention / Treatment
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* Device: snifﬁng Position(place a 7-cm cushion under head )
* Device: Simple Head Extension(without cushion)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI greater than 30 kg/m2 ASA classifications of I-II, modified Mallampati classification of 3 or 4, requiring general anesthesia were included. Exclusion Criteria: Exclusion criteria included age younger than 18 yr ASA class IV or V Abnormalities of the heart, brain, liver, lung, kidney and coagulation functions

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: snifﬁng Position<br>Awake fiberoptic bronchoscope(FOB) orotracheal under snifﬁng position.The snifﬁng position was obtained by placement of a 7-cm cushion under the head of the patient. When the FOB was inserted into oral cavity, and the epiglottis and glottis were identified by the FOB. The anterior of FOB was inserted deep into tracheal after the glottis was exposed sufficiently then the tracheal tube was pushed into the trachea via the FOB | Device: snifﬁng Position(place a 7-cm cushion under head )<br>* Awake fiberoptic bronchoscope(FOB) orotracheal under snifﬁng position.The snifﬁng position was obtained by placement of a 7-cm cushion under the head of the patient. When the FOB was inserted into oral cavity, and the epiglottis and glottis were identified by the FOB. The anterior of FOB was inserted deep into tracheal after the glottis was exposed sufficiently then the tracheal tube was pushed into the trachea via the FOB<br>|
| Experimental: Simple Head Extension<br>Awake fiberoptic bronchoscope(FOB) orotracheal under Head Extension position.The Head Extension position was obtained by simple head extension.When the FOB was inserted into oral cavity, and the epiglottis and glottis were identified by the FOB. The anterior of FOB was inserted deep into tracheal after the glottis was exposed sufficiently then the tracheal tube was pushed into the trachea via the FOB | Device: Simple Head Extension(without cushion)<br>* Awake fiberoptic bronchoscope(FOB) orotracheal under Head Extension position.The Head Extension position was obtained by simple head extension.When the FOB was inserted into oral cavity, and the epiglottis and glottis were identified by the FOB. The anterior of FOB was inserted deep into tracheal after the glottis was exposed sufficiently then the tracheal tube was pushed into the trachea via the FOB<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intubation Time | The primary endpoints were the time to view the vocal cords (TVC) which was taken when the operator indicated verbally that he view the vocal cords and the time to successful tracheal intubation (TSI). TSI was defined as the time taken from insertion of the FOB between the teeth until the appearance of a capnograhy curve. | Ten minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of throat pain measured by VAS |  | one day Postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Snifﬁng Position, Simple Head Extension, neutral position