Video-laryngoscope With a Novel Video-stylet for Difficult Intubation

Feasibility of a Combined Use of a Video-laryngoscope With a Novel Video-stylet for Predicted Difficult Intubation

We propose to enroll 140 subjects scheduled for elective or urgent/emergent surgery with general anesthesia including endotracheal intubation. Patients qualify for the trial if they are considered a difficult airway case as determined by measurement of common predictive indices for difficult intubation (see inclusion criteria). All patients will be intubated with a GVL. Patients will be randomly assigned to either having their ETT placed with use of a pre-formed stylet provided by the manufacturer of the GVL (control group) or with a flexible, disposable tracheoscope (aScope, Ambu, Denmark) (intervention group). The randomization will be stratified as to whether patients are categorized as predicted difficult airway or have an immobilized cervical spine (C-collar in place).

Inclusion Criteria:

• BMI > 35
• Thyromental distance < 6 cm
• Sterno-mental distance < 12 cm
• Mallampati grade 3 and 4
• Interincisor distance < 38 mm
• Status of dentition: presence of buckteeth
• Neck movement < 35°
• Neck circumference >43 cm at the level of the thyroid cartilage
• Patients with immobilized cervical spine (C-collar in place).
• History of difficult laryngoscopy or intubation

Exclusion Criteria:

• Full stomach
• Hiatal hernia
• Severe GERD (Gastroesophageal reflux disease)
• Tumors of the upper airway