Comparison of Intubating Conditions in 25° Head-up Position and Strict Supine

Study Overview
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Brief Summary
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Tracheal intubation, particularly before surgery, is traditionally done in supine position. It was shown in the general population and in obese patients in particular, that the pre-oxygenation in a 25° head-up position provided a better efficiency of the pre-oxygenation and an apnea time longer. This position would also allow for better intubation conditions in direct laryngoscopy. The investigators intend to assess two different patient's intubation position : supine position and 25° head-up position

Detailed Description
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Randomization assigned in random block, stratification by operator (20 patients per operator, 10 in each group). Interim analysis every 100 patients.

Official Title
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Comparison of Intubating Conditions in 25° Head-up Position and Strict Supine

Conditions
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Intubation, Intratracheal

Intervention / Treatment
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* Procedure: Intubation position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - patients scheduled for various surgeries requiring general anesthesia with curare, with intubation of the trachea, eligible for intubation by direct laryngoscopy. > 18 years patients with social security Exclusion Criteria: Emergency surgery. Patient who requiring rapid sequence induction. Intubation without curare. Expected difficult intubation with planned modification of the intubation protocol (i. e. intubation under fibroscopy, airtrach or videolaryngoscopy) Patient with a history of epilepsy, pulmonary or cardiovascular disease (including ischemic heart disease, symptomatic asthma or obstructive pulmonary disease). Patient with mask phobia. BMI> 30kg / m2 Patient who are refusing to take part. Patient protected major, minor, pregnant women, patients deemed incapable of giving informed consent.

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

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: supine position<br>Patients are placed in the supine position at 0° from arrival in the room until intubation | Procedure: Intubation position<br>* The investigators assess two different patient's intubation position : supine position and 25° head-up position looking at the intubation score (POGO score).<br>|
| Active Comparator: 25° head-up position<br>Patients are placed in the 25° head-up position (half-seat or whole body proclive) from arrival in the room until intubation. | Procedure: Intubation position<br>* The investigators assess two different patient's intubation position : supine position and 25° head-up position looking at the intubation score (POGO score).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| POGO score | valid score observed by the anesthetist performing intubation at the time of intubation. POGO score means Percentage of Glottic Opening : from 0% (none visualization of the glottic opening, worst result) to 100% (complete visualization of the glottic opening, best result), from the anterior curvature of the vocal cords to the interarytenoid node, between the posterior cartilage | at day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cormack-Lehane grade | another valid score observed by the anesthetist performing intubation at the time of intubation. It classifies views obtained by direct laryngoscopy based on the structures seen. From 1 (best result) to 4 (worst result). 1 : full view of glottis (POGO 100%) / 2 : partial view of glottis / 3 : only epiglottis seen, none of glottis seen (POGO 0%) / 4 : Neither glottis nor epiglottis seen (POGO 0%). | at day 1 | 
| Intubation operator's comfort | visual analog scale about the operator's comfort during intubation. It's a subjective score. It's an evaluation of the comfort of the intubation position from 0 to 10, where 0 is a total discomfort, a painful, very uncomfortable position and 10 is an optimal, very comfortable position. | at day 1 | 
| Episodes of desaturation and episodes of hypotension | SpO2 <90% or MAP <65mmHg or drop> 20% of the patient's baseline SBP | at ady 1 | 
| Mechanical complications of intubation: | laryngeal pain, hoarseness, upper airway trauma | at day 1 | 
| Patient height | at the tragus of the ear during intubation. | at day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Intubation conditions, Anaesthetic techniques, Laryngoscopy