Comparing the Snifing 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 Nasotracheal intubation via fiberoptic bronchoscope (FOB) . However, no study confirmed its superiority oversnifing position and Neutral Position. In a prospective, randomized study, the authors compared the snifing position , simple head extension and Neutral Position in Nasotracheal intubation via fiberoptic bronchoscope.

Detailed Description
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The study included ninety patients with anticipated difficult airways. The snifing position was obtained by placement of a 7-cm cushion under the head of the patient; the extension head position was obtained by placement of a 7-cm cushion under the shoulder; the neutral position with the occiput close to the operating table. The head position was randomized as follows: neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). Randomization (1:1:1) was based on the codes generated by Excel software, which were kept in sequentially numbered opaque envelopes until the began of study.

Official Title
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First Hospital of Qinhuangdao，Hebei Province, China

Conditions
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Therapeutic Procedural Complication

Intervention / Treatment
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* Other: Head position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • ASA classifications of I-II, modified Mallampati classification of 3 or 4, requiring general anesthesia were included. Exclusion Criteria: • 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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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: snifing Position<br>Nasotracheal intubation via fiberoptic bronchoscope under snifing position.The snifing position was obtained by placement of a 7-cm cushion under the head of the patient. When the FOB was inserted into Nasal 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. | Other: Head position<br>* Influence of different head position on nasal endotracheal intubation<br>|
| Experimental: neutral position<br>Nasotracheal intubation via fiberoptic bronchoscope under snifing position.The Head Extension was obtained by the occiput of the patient close to the operating table. When the FOB was inserted into Nasal 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. | Other: Head position<br>* Influence of different head position on nasal endotracheal intubation<br>|
| Experimental: Head Extension<br>Nasotracheal intubation via fiberoptic bronchoscope under snifing position.The extension position with a 7-cm pillow underneath the shoulder and the occiput close to the operating table. When the FOB was inserted into Nasal 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. | Other: Head position<br>* Influence of different head position on nasal endotracheal intubation<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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Snifing Position, Simple Head Extension, neutral position, Nasotracheal intubation