Tube 1st Technique for Easy Fiberoptic Intubation

Study Overview
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Brief Summary
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the aim of this work is to study how this technique will make nasal fiberoptic intubation easier and faster than the usual classic technique

Detailed Description
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Difficult intubation is one of the most significant issues anesthesiologists deal with, occasionally. Among these, mandibulofacial deformities face the biggest challenge in intubation and make an anticipated difficult airway (1), due to short length of mandible (HLM), short thyromental distance (TMD), short inter horizontal -incisors gap (IIG) and high grade modified Mallampati test (MMT) (2). There are several strategies to approach these patients and each technique has unique benefits that should be used on experience. Sitting endotracheal intubation is a useful technique for airway control, in patients with difficult airway or in patients in whom maintenance of the upright posture is beneficial (3), A difficult airway is defined as difficulty with facemask ventilation, difficulty with tracheal intubation, or both (3). According to new updates on difficult airway management, by the American Society of Anesthesiologists, there are non-invasive and invasive interventions for the management of difficult airway. Non-invasive interventions include, without being limited to: awake intubation, video-assisted laryngoscopy, intubating stylets or tube-changers, supraglottic airway (SGA) for ventilation (e.g., LMA, laryngeal tube), SGA for intubation (e.g., ILMA), rigid laryngoscopic blades of variousdesign and size, fiberoptic-guided intubation, and lighted stylets or light wands, while invasive interventions include surgical or percutaneous airway, jet ventilation and retrograde intubation (4). Attaching a nasal airway to a breathing circuit as a tool to assist or control ventilation is a very helpful trick to have in challenging airway management situations. Typically, Fiberoptic bronchoscope is passed through the more patent nostril to follow the major nasal pathway at the floor of the nose along the superior aspect of the hard palate, the lateral aspect of the nasal septum inferior to the lower turbinate to reach the nasopharynx where the operator identifies the pharyngeal structures, such as the base of the tongue and/or the epiglottis that are mostly in-fall precluding clear views of the larynx requiring a jaw thrust to visualize the laryngeal structures for patients planned to be intubated under general anesthesia [5,6].

Official Title
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Tube First Technique as a Conduit for Easy and Fast Firberoptic Intubation

Conditions
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Difficult Intubation

Intervention / Treatment
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* Other: fiberoptic intubation classic technique
* Other: fiberoptic intubation tube 1st technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 20 and 60 years, ASA Class I& II, Maxillofacial surgeries ex: mandibular surgery, orthognathic surgery and dental extraction surgery, Other surgeries like: oral graft surgery, facial trauma, limited mouth opening ex: submandibular and facial abscess. Exclusion Criteria: Patient's refusal, ASA III or more, Intrinsic and idiopathic coagulopathy, known allergy to any of the study medications, furthermore, patients were excluded if they had severe hypoxemias due to sever cardiac or lung disease

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 60 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: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: classic group (CL group)<br>20 patients will be enrolled to be intubated using the classic usual technique | Other: fiberoptic intubation classic technique<br>* classic fiberoptic intubation<br>|
| Other: tube 1st group (TF group)<br>20 patients will be enrolled to be intubated using the tube 1st technique | Other: fiberoptic intubation tube 1st technique<br>* tube 1st technique<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| time 1 | time 1 = time from start from start of introducing the bronchoscope till viewing the vocal cord measured in seconds. | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| other measures | 1. total dose of propofol during procedure measured in mg | baseline |