Difficult Intubation Clinical Trial
Official title:
Macintosh Laryngoscope Assisted Flexible Fiber Optic Endotracheal Intubation Versus Classic Fiber Optic Laryngoscope Alone Endotracheal Intubation for Modified Mallampati III&IV Patients : A Prospective Randomized Controlled Study
During fiberoptic endotracheal intubation, the perfect airway exposure produced by the classic curved Macintosh laryngoscope in place of head tilt -chin lift-jaw thrust maneuver may increase the accuracy and produce rapid direct vocal cord access in a short time under Inhalation anesthesia to maintain the respiratory drive for grade III&VI Modified Mallampati .
Managing difficult airway is critical for anesthesia-related morbidity and mortality.
Fiberoptic laryngoscope is a reliable tool for endotracheal intubation in difficult airway
cases (Modified Mallampatti III&IV), but always there is difficulty to visualize the glottis
due to airway tendency to collapse, classically a specific fiberoptic airway with a side way
is used and it may added head tilt chin lift jaw thrust. A new technique utilizing
sevoflurane anesthesia to maintain the respiratory drive without exposing the patient to the
stress of the awake airway instrumentation. Simultaneous utilization of both Macintosh curved
laryngoscope and Fiberoptic bronchoscope during Endotracheal intubation (ETT) will be
examined for the efficacy during difficult airway management.
All patients should be examined preoperatively for the scoring Modified Mallampati or non
tongue protrusion mallampati (NT-MMT) airway score. The pharyngeal structures were then
evaluated and the best view (lowest class) was recorded. The classification follows m-MMT and
is as follows: class 1, full visibility of tonsils, uvula, and soft palate; class 2,
visibility of hard and soft palate, upper portion of tonsils and uvula; class 3, visibility
of the soft and hard palate and base of the uvula; and class 4, visibility of only the hard
palate, class III or IV patients were included in the study. Inhalational anesthesia use
maintains the respiratory drive of the patient allowing less stressful technique.
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