New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway

Study Overview
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Brief Summary
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We propose the additional technique of lingual traction or tongue pulling in conjunction with use of the flexible fiberoptic bronchoscope for facilitating successful first attempts at and decreasing time to intubation of the difficult airway and rescuing otherwise failed intubation attempts. Induction of general anesthesia causes relaxation and approximation of the soft palate, base of the tongue, epiglottis, and posterior pharyngeal wall, creating unfavorable anatomic changes in the pharynx for successful intubation. The use of lingual traction can assist in diminishing these problems by clearing the tongue away from the soft palate and uvula and lifting the epiglottis from the posterior pharyngeal wall, especially in the unanticipated difficult airway patient.

Official Title
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New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway: A Prospective, Randomized Study

Conditions
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Anticipated Difficult Airway

Intervention / Treatment
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* Other: Lingual Traction
* Other: Sham
* Device: Fiberoptic Intubation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: > 18 years old With ASA (American Society of Anesthesiologists) physical status I-III With anticipated difficult airway Scheduled for elective surgery requiring orotracheal intubation (populations such as elective hip and knee arthroplasty patients) Provide written consent Exclusion Criteria: With (American Society of Anesthesiologists) ASA physical status IV Pregnant Require rapid-sequence induction Require a non-standard tracheal tub Unable to provide written consent At risk for pulmonary aspiration of gastric content

Ages Eligible for Study
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Minimum Age: 18 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

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Fiberoptic Intubation Alone<br>Intubation with fiberoptic scope assistance | Other: Sham<br>* Standard of care fiberoptic intubation without any additional experimental maneuvers<br>Device: Fiberoptic Intubation<br> <br> |
| Experimental: Fiberoptic Intubation with lingual traction<br>Intubation with fiberoptic scope assistance and lingual traction maneuver provided by a second anesthesiologist | Other: Lingual Traction<br>* The tongue pulling maneuver consists of grasping the tongue with 4x4cm gauze and gently pulling the tongue out until resistance is met.<br>Device: Fiberoptic Intubation<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Successful Intubations on First Attempt; Grade(s) Were Not Measured. |  | At Intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sore Throat Grade on First Postoperative Day | Patients will be asked to rate their sore throat qualitatively as none, mild, moderate, or severe | Postoperative day one |