Clinical trial NCT06972394: Videolaryngoscopy at Unanticipated Difficult Airway
Official title: Should Videolaryngoscopy Enter Routine Use? Unanticipated Difficult Airway: A Five-Year Experience in a Tertiary Care Hospital
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Difficult Airway
Videolaryngoscopy
Keywords: Anesthesia
intubation
airway management
laryngoscopy
difficult airway
videolaryngoscopy
Lead sponsor: Tokat Gaziosmanpasa University
Sponsor class: OTHER
First posted: 2025-05-15
Enrollment: 143
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Data of patients with no signs of difficult airway (unanticipated difficult airway) in preoperative evaluation will be investigated retrospectively.

Brief summary: Glottic visualization, intubation success, complications and accidental esophageal intubation rate of direct laryngoscopy (DL) and videolaryngoscopy (VL) were compared in patients with UDA.

Detailed description: Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Tokat Gaziosmanpaşa University (25-MOBAEK-124). Data were collected by reviewing hospital automation systems, patient records, and difficult airway forms for patients who underwent elective surgery under general anesthesia and experienced unanticipated difficult airway (UDA) between January 2020 and March 2025. Patients with incomplete data, a prior history of difficult airway, or preoperative findings indicating a difficult airway were excluded from the study. Demographic variables-including age, gender, body mass index, comorbidities, and ASA scores-as well as airway examination findings such as Mallampati scores and Cormack-Lehane grades, were analyzed. Additionally, intubation methods, instruments used, and challenges encountered during airway management were evaluated. The effects of direct laryngoscopy (DL) and videolaryngoscopy (VL) on glottic visualization, intubation success, and complication rates were also compared.

In the relevant clinic, preoperative airway evaluation is performed by assessing the Mallampati classification, thyromental distance, sternomental distance, inter-incisor gap and angle, neck circumference, atlanto-occipital joint mobility, upper lip bite test, retrognathia, prominent upper incisors, high and narrow palate, macroglossia, hoarseness, dyspnea on exertion, and history of difficult airway. In patients without any predictors of difficult airway, routine intubation is performed using DL in the sniffing position. The management of patients with UDA is conducted according to a specific institutional protocol. In appropriate cases where mask ventilation and oxygenation can be maintained, a hyper-angulated C-MAC® D-Blade videolaryngoscope (Karl Storz, Tuttlingen, Germany) is used as a rescue technique in patients who cannot be intubated using DL. If tracheal intubation cannot be achieved with videolaryngoscopy or other methods and the patient is awakened, and if the surgical procedure still requires general anesthesia, awake intubation using fiberoptic bronchoscopy (FOB) is planned.

Eligibility criteria: Inclusion Criteria:

* Patients aged 18 to 90 years
* Patients with unanticipated difficult airway

Exclusion Criteria:

* Patients with missing data
* Patients with a history of difficult airway
* Patients with signs of difficult airway on preoperative evaluation

Primary outcomes:
measure: Intubation success
timeFrame: From anesthesia induction until the attempt of intubation is completed (peri-induction period).
Secondary outcomes:
Other outcomes:
Locations:
city: Tokat
country: Turkey
facility: Tokat Gaziosmanpasa University
state: Center
Study officials:
References: