Head and Neck Position for Intubation Clinical Trial
Official title:
Optimal Head and Neck Position for Intubation During Videolaryngoscopy: Comparison Between "Sniffing" and Neutral Position Using Channelled and Non-channelled Videolaryngoscopes
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.
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.
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