Dysphagia Clinical Trial
Official title:
Initial Increase in Cuff Pressure After Neck Retraction for Anterior Spine Surgery: Comparison Between Orotracheal and Nasotracheal Intubation
When the retractor blades oped and is positioned to provide the surgical access in the anterior cervical spine surgery, it cause the trachea to deviate laterally and pose pressure on the tissue between the retractor and the trachea. This is convincible as revealed by the increase of cuff pressure of endotracheal tube. The study aims to investigate differences in the increase of cuff pressure after retractor is positioned between nasotracheal and orotracheal intubation.
When the retractor blades oped and is positioned to provide the surgical access in the
anterior cervical spine surgery, it cause the trachea to deviate laterally and pose pressure
on the tissue between the retractor and the trachea. The most important structure is the
recurrent laryngeal nerve. This is convincible as revealed by the increase of cuff pressure
of endotracheal tube. The pressure created by the retractor may be related to postoperative
dysphonia and dysphagia. In view of minimizing the pressure created by the retractors, some
neurosurgeons advocate to deflate then to inflate the cuff of ETT tube after the retractor is
on, while some advocate monitoring of cuff pressure and keep below 25 mmHg. Nasotracheal or
orotracheal tube can both be applied to general anesthesia for the anterior cervical spine
surgery. The option depends on the surgeons' preference. Though both approaches end at the
trachea, the nasotracheal tube is fixed at the nostril, and orotracheal tube, at the mouth
angle, on the opposite side of surgical approach. The investigators hypothetize this
difference in location results in different degree of deviation and increase of cuff
pressure. The study aims to investigate differences in the increase of cuff pressure after
retractor is positioned between nasoendotracheal and oroendotracheal intubation.
Apfelbaum and colleagues indicated the asymmetric position of the oroETT within the larynx as
being fixed distally by the cuff and proximally by taping at the mouth angle. The asymmetry
of the tube shaft and cuff may contribute to unilateral vocal palsy. When the retractors are
set up for ACCS, the deviation of cuff towards the retractors increases ETCP and creates a
extrusion compression of tissues in between the cuff and the retractor blade. Nasotracheal
intubation follows a more natural trajectory into the trachea. In theory, a nasoETT is more
centrally located and less asymmetric in the thyroid cartilage and trachea; thus pressure
from this tube may be relatively evenly distributed, and the pressure on the surrounding
tissues is lower. Therefore, we hypothesised lower degree of tissue compression with a
nasoETT, even during retractor splay. The effect may be reflected in intraoperative ETCP or
post-ACCS dysphonia. This randomised controlled clinical trial assessed the differences in
the tracheal intubation mode on the maximal ETCP during retractor splay (primary endpoint)
and post-ACSS dysphonia (secondary endpoint).
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Active, not recruiting |
NCT03711474 -
Dysphagia Following Anterior Cervical Spine Surgery; Single Dose Steroid vs Saline (DysDexVSSal)
|
Phase 4 | |
Enrolling by invitation |
NCT04074356 -
Non-invasive Markers of Esophageal Function in Adults
|
N/A | |
Suspended |
NCT04349462 -
Post Critical Illness Dysphagia in the Intensive Care Unit
|
N/A | |
Not yet recruiting |
NCT05982977 -
Study on the Effect Mechanism of Acupuncture Combined With Swallowing Training in Oral Dysphagia of Stroke
|
N/A | |
Recruiting |
NCT03605381 -
MORbidity PRevalence Estimate In StrokE
|
||
Active, not recruiting |
NCT03455608 -
PRO-ACTIVE: Prophylactic Swallow Intervention for Patients Receiving Radiotherapy for Head and Neck Cancer
|
N/A | |
Active, not recruiting |
NCT03604822 -
Music Therapy Protocol to Support Bulbar and Respiratory Functions in ALS
|
N/A | |
Recruiting |
NCT03682081 -
Interventions for Patients With Alzheimer's Disease and Dysphagia
|
N/A | |
Completed |
NCT05700838 -
Refining Cough Skill Training in Parkinson's Disease and Dysphagia
|
Phase 1 | |
Not yet recruiting |
NCT04064333 -
Slow-Stream Expiratory Muscle Strength Training for Veterans With Dysphagia Living in Long-term Care
|
N/A | |
Not yet recruiting |
NCT02724761 -
Prophylactic Racemic Epinephrine in Anterior Cervical Discectomy and Fusion
|
N/A | |
Completed |
NCT02927691 -
Novel Management of Airway Protection in Parkinson's Disease: A Clinical Trial
|
Phase 2 | |
Completed |
NCT01919112 -
Fostering Eating After Stroke With Transcranial Direct Current Stimulation
|
N/A | |
Completed |
NCT01370083 -
Tongue Pressure Profile Training for Dysphagia Post Stroke
|
Phase 2 | |
Completed |
NCT01723358 -
Neuromuscular Electrical Stimulation (NMES) Treatment Technique Therapy in the Management of Young Infants With Severe Dysphagia
|
Phase 2 | |
Withdrawn |
NCT01200147 -
Effectiveness of Rupture of Schatzki's Ring Using Biopsy Forceps Versus SIngle Dilation
|
N/A | |
Completed |
NCT00570557 -
Development of a Web-Based Course to Maintain Skills in Nurses Trained to Screen for Dysphagia
|
N/A | |
Recruiting |
NCT00166751 -
Sonographic Assessment of Laryngeal Elevation
|
N/A | |
Completed |
NCT00717028 -
Functional Endoscopic Evaluation of Swallowing
|
N/A | |
Completed |
NCT01476241 -
Percutaneous Endoscopic Gastrostomy Tube Placement by Otorhinolaryngologist
|
N/A |