Macintosh Laryngoscope Assisted Fiberoptic Intubation

Study Overview
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Brief Summary
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During fiberoptic endotracheal intubation, the perfect airway exposure produced by the classic curved Macintosh laryngoscope in place of head tilt -chin lift-jaw thrust maneuver may increase the accuracy and produce rapid direct vocal cord access in a short time under Inhalation anesthesia to maintain the respiratory drive for grade III&VI Modified Mallampati .

Detailed Description
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Managing difficult airway is critical for anesthesia-related morbidity and mortality. Fiberoptic laryngoscope is a reliable tool for endotracheal intubation in difficult airway cases (Modified Mallampatti III&IV), but always there is difficulty to visualize the glottis due to airway tendency to collapse, classically a specific fiberoptic airway with a side way is used and it may added head tilt chin lift jaw thrust. A new technique utilizing sevoflurane anesthesia to maintain the respiratory drive without exposing the patient to the stress of the awake airway instrumentation. Simultaneous utilization of both Macintosh curved laryngoscope and Fiberoptic bronchoscope during Endotracheal intubation (ETT) will be examined for the efficacy during difficult airway management. All patients should be examined preoperatively for the scoring Modified Mallampati or non tongue protrusion mallampati (NT-MMT) airway score. The pharyngeal structures were then evaluated and the best view (lowest class) was recorded. The classification follows m-MMT and is as follows: class 1, full visibility of tonsils, uvula, and soft palate; class 2, visibility of hard and soft palate, upper portion of tonsils and uvula; class 3, visibility of the soft and hard palate and base of the uvula; and class 4, visibility of only the hard palate, class III or IV patients were included in the study. Inhalational anesthesia use maintains the respiratory drive of the patient allowing less stressful technique.

Official Title
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Macintosh Laryngoscope Assisted Flexible Fiber Optic Endotracheal Intubation Versus Classic Fiber Optic Laryngoscope Alone Endotracheal Intubation for Modified Mallampati III&IV Patients : A Prospective Randomized Controlled Study

Conditions
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Difficult Intubation

Intervention / Treatment
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* Device: fiberoptic, airway
* Device: fiberoptic, Machintosh


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients with Modified Mallampati (NT-MMT) airway score III,VI American Society of Anaesthesiologists (ASA) physical class I-III Scheduled for elective cancer surgery under general anesthesia Exclusion Criteria: Modified Mallampati I,II Airway scored patients. History of upper airway surgery. Patients with serious deformities of the mandible, maxilla, tongue, pharynx or larynx. Patients with a history of significant cardiac and pulmonary diseases, Obesity with BMI >40, Epilepsy, pregnancy, mental disease, neurological psychological disorders. Communication barrier.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: fiberoptic, airway<br>Classical fiberoptic intubation assisted by side fenestrated airway and head tilt- chin lift- jaw thrust by 2 anesthetist | Device: fiberoptic, airway<br>* classic fiberoptic bronchoscope, fenstrated airway<br>|
| Experimental: fiberoptic, Machintosh<br>oral Fiberoptic bronchoscopic intubation assisted by Macintosh Laryngoscope, by 2 anesthetist | Device: fiberoptic, Machintosh<br>* oral fiberoptic brochoscopic, Machintosh laryngoscope<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intubation time | time from introduction of the tip of the fiber optic laryngoscope till insertion of the tube in the laryngeal inlet down in the trachea in seconds. | during intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| lower jaw relaxation | (Relaxed= 0, not fully=1, poor= 2) | during intubation | 
| Vocal cord position | (Abducted= 0, Intermediate opening= 1, Closed= 2) | during intubation | 
| Neck movements | for endotracheal tube or cuff inflation (no=0, slight= 1, vigorous= 2), | during intubation and cuff inflation | 
| Cough | (absent= 0, present=1) | during intubation and cuff inflation | 
| 1st trial success rate | in percent | during intubation | 
| the number of trails | (1st trial=1, 2nd trial= 2, 3rd trial= 3) | during intubation | 
| mean arterial Blood pressure (MBP) | basal, every minute during intubation, 1, 3, 5 minutes after intubation | during intubation till 5 minutes after intubation | 
| mean heart rate (HR) | basal, every minute during intubation, 1, 3, 5 minutes after intubation | during intubation till 5 minutes after intubation | 
| desaturation (SpO2) | oxygen saturation <90% .(Yes=1, No= 0) | during intubation |