Clinical trial NCT01958346: New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway
Official title: New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway: A Prospective, Randomized Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Anticipated Difficult Airway
Lead sponsor: University of South Florida
Sponsor class: OTHER
First posted: 2013-10-09
Enrollment: 78
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: We propose the additional technique of lingual traction or "tongue pulling" in conjunction with use of the flexible fiberoptic bronchoscope for facilitating successful first attempts at and decreasing time to intubation of the difficult airway and rescuing otherwise failed intubation attempts. Induction of general anesthesia causes relaxation and approximation of the soft palate, base of the tongue, epiglottis, and posterior pharyngeal wall, creating unfavorable anatomic changes in the pharynx for successful intubation. The use of lingual traction can assist in diminishing these problems by clearing the tongue away from the soft palate and uvula and lifting the epiglottis from the posterior pharyngeal wall, especially in the unanticipated difficult airway patient.


Eligibility criteria: Inclusion Criteria:

* \> 18 years old
* With ASA (American Society of Anesthesiologists) physical status I-III
* With anticipated difficult airway
* Scheduled for elective surgery requiring orotracheal intubation (populations such as elective hip and knee arthroplasty patients)
* Provide written consent

Exclusion Criteria:

* With (American Society of Anesthesiologists) ASA physical status IV
* Pregnant
* Require rapid-sequence induction
* Require a non-standard tracheal tub
* Unable to provide written consent
* At risk for pulmonary aspiration of gastric content

Primary outcomes:
measure: Number of Participants With Successful Intubations on First Attempt; Grade(s) Were Not Measured.
timeFrame: At Intubation
Secondary outcomes:
measure: Sore Throat Grade on First Postoperative Day
timeFrame: Postoperative day one
Other outcomes:
Locations:
city: Tampa
country: United States
facility: Tampa General Hospital
state: Florida
Study officials:
affiliation: Florida Gulf-to-Bay Anesthesiology
name: Devanand Mangar, MD
role: STUDY_DIRECTOR
References:
citation: Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005 Jul;103(1):33-9. doi: 10.1097/00000542-200507000-00009.
citation: Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251-70. doi: 10.1097/ALN.0b013e31827773b2. No abstract available.
citation: Umesh G, George M, Venkateswaran R. Tongue traction is as effective as jaw lift maneuver for Trachlight-guided orotracheal intubation. Acta Anaesthesiol Taiwan. 2010 Sep;48(3):130-5. doi: 10.1016/S1875-4597(10)60044-6.
citation: Rewari V, Ramachandran R, Trikha A. Lingual traction: a useful manoeuvre to lift the epiglottis in a difficult oral fibreoptic intubation. Acta Anaesthesiol Scand. 2009 May;53(5):695-6. doi: 10.1111/j.1399-6576.2009.01934.x. No abstract available.