Optimal Head and Neck Position During Videolaryngoscopy

Study Overview
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Brief Summary
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Optimal patient head and neck position when performing videolaryngoscopy for endotracheal intubation has not yet been established.The investigators aim to assess the effect of two different positions on the laryngeal view obtained and success of tracheal intubation during videolaryngoscopy with two commercially available and well established videolaryngoscopes.

Detailed Description
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The optimum patient head and neck position for direct laryngoscopy (when the anaesthetist views the larynx with a curved metallic blade before passing a tube for ventilation of the lungs) is traditionally considered to be the sniffing the morning air (neck flexion and head extension) position. This has been questioned previously as there is no randomized controlled study to date to explore this statement. The patient should be optimally positioned prior to induction of anaesthesia, especially because in the event of an unexpected difficult intubation, the Difficult Airway Society guidelines suggest the use of an alternative laryngoscope. In current clinical practice a videolaryngoscope (a curved blade with a camera attached to it that allows the anaesthetist to see around corners) has been used as an alternative laryngoscope. To the best of our knowledge, the ideal patient position for videolaryngoscopy has not yet been described. The intubation time and rate of success at intubation using a C-Mac D-Blade videolaryngoscope was previously assessed by Serocki et al, but only in the sniffing position. It is possible that adopting a different position when using the C-Mac D- Blade might result in a superior view of the larynx. Furthermore, the optimal patient position has not yet been assessed for intubation with the King Vision videolaryngoscope. This key information could gain precious seconds in a difficult airway scenario (when securing the airway with a tube for ventilation proves difficult) and has obvious implications for patient management. The answer to this question could also help the anaesthetists take informed decisions when using videolaryngoscopy to intubate the trachea in elective settings. The investigators aim to assess the effect of two different positions on the laryngeal view obtained during videolaryngoscopy with two commercially available and well established videolaryngoscopes to try and answer this question.

Official Title
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Optimal Head and Neck Position for Intubation During Videolaryngoscopy: Comparison Between Sniffing and Neutral Position Using Channelled and Non-channelled Videolaryngoscopes

Conditions
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Head and Neck Position for Intubation

Intervention / Treatment
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* Other: C-Mac D-Blade Videolaryngoscope
* Other: C-Mac D-Blade Videolaryngoscope
* Other: King Vision Videolaryngoscope
* Other: King Vision Videolaryngoscope


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients aged 18 and above, presenting for elective surgical procedure and requiring tracheal intubation will be invited to take part in the study. Exclusion Criteria: Patients who are refusing to take part, below 18 years of age, pregnant women, American society of anaesthesiologists' class 4 and above, those requiring rapid sequence indication, super morbidly obese (BMI >50) and those patients requiring awake fibreoptic intubation will be excluded.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: C-Mac D-Blade Neutral Position<br>C-Mac D-Blade videolaryngoscope with patients head and neck in neutral position. | Other: C-Mac D-Blade Videolaryngoscope<br>* Using C-Mac D-Blade Videolaryngoscope patients will be positioned the neutral Head and Neck Position<br>|
| Active Comparator: C-Mac D-Blade Sniffing Position<br>C-Mac D-Blade videolaryngoscope with patients head and neck in sniffing position. | Other: C-Mac D-Blade Videolaryngoscope<br>* Using C-Mac D-Blade Videolaryngoscope patients will be positioned in Sniffing Head and Neck Position<br>|
| Active Comparator: King Vision Neutral Position<br>King Vision videolaryngoscope with patients head and neck in neutral position. | Other: King Vision Videolaryngoscope<br>* Using the King Vision Videolaryngoscope patients will be positioned in the neutral Head and Neck Position<br>|
| Active Comparator: King Vision Sniffing Position<br>King Vision videolaryngoscope with patients head and neck in sniffing position. | Other: King Vision Videolaryngoscope<br>* Using the King Vision Videolaryngoscope patients will be positioned in Sniffing Head and Neck Position<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Optimal Head and Neck Position during Videolaryngoscopy | This will be assessed using a Difficult Intubation Scale Score for each of the 2 videolaryngoscopes used in the study, which will be assessed in both neutral and sniffing positions. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Laryngoscopy Time | From when the laryngoscope enters the mouth until achieving the best view of the larynx. | Less than 1 minute | 
| Intubation Time | from entering the mouth with the videolaryngoscope until endotracheal tube is inserted in the wind-pipe and the capnography trace is first visible on the screen. | Less than 1 minute | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Head Neck Position Videolaryngoscopy