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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fiberoptic Intubation Alone | Sham Comparator | Intubation with fiberoptic scope assistance |
|
| Fiberoptic Intubation with lingual traction | Experimental | Intubation with fiberoptic scope assistance and lingual traction maneuver provided by a second anesthesiologist |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lingual Traction | Other | The tongue pulling maneuver consists of grasping the tongue with 4x4cm gauze and gently pulling the tongue out until resistance is met. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Successful Intubations on First Attempt; Grade(s) Were Not Measured. | At Intubation |
| Measure | Description | Time Frame |
|---|---|---|
| Sore Throat Grade on First Postoperative Day | Patients will be asked to rate their sore throat qualitatively as none, mild, moderate, or severe | Postoperative day one |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Devanand Mangar, MD | Florida Gulf-to-Bay Anesthesiology | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tampa General Hospital | Tampa | Florida | 33606 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15983454 | Background | 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. | |
| 23364566 | Background | 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. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Fiberoptic Intubation Alone | Sham: Standard of care fiberoptic intubation without any additional experimental maneuvers Fiberoptic Intubation |
| FG001 | Fiberoptic Intubation With Lingual Traction | Lingual Traction: The tongue pulling maneuver consists of grasping the tongue with 4x4cm gauze and gently pulling the tongue out until resistance is met. Fiberoptic Intubation |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Fiberoptic Intubation Alone | Sham: Standard of care fiberoptic intubation without any additional experimental maneuvers Fiberoptic Intubation |
| BG001 | Fiberoptic Intubation With Lingual Traction |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Successful Intubations on First Attempt; Grade(s) Were Not Measured. | Posted | Number | participants | At Intubation |
|
Post operative day 1
Sore throats were qualitatively scored by the patient as none, mild, moderate, or severe.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Fiberoptic Intubation Alone | Sham: Standard of care fiberoptic intubation without any additional experimental maneuvers Fiberoptic Intubation |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Sore Throat | Injury, poisoning and procedural complications | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Devanand Mangar MD | Teamhealth Anesthesia | 813-844-4434 | devanandmangar@teamhealth.com |
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| ID | Term |
|---|---|
| C005703 | salicylhydroxamic acid |
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| Sham | Other | Standard of care fiberoptic intubation without any additional experimental maneuvers |
|
| Fiberoptic Intubation | Device |
|
| 20864061 | Background | 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. |
| 19419380 | Background | 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. |
Lingual Traction: The tongue pulling maneuver consists of grasping the tongue with 4x4cm gauze and gently pulling the tongue out until resistance is met.
Fiberoptic Intubation
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units |
|---|
| Counts |
|---|
| Participants |
|
|
| Secondary | Sore Throat Grade on First Postoperative Day | Patients will be asked to rate their sore throat qualitatively as none, mild, moderate, or severe | Posted | Number | participants | Postoperative day one |
|
|
|
| 0 |
| 39 |
| 3 |
| 39 |
| EG001 | Fiberoptic Intubation With Lingual Traction | Lingual Traction: The tongue pulling maneuver consists of grasping the tongue with 4x4cm gauze and gently pulling the tongue out until resistance is met. Fiberoptic Intubation | 0 | 39 | 6 | 39 |
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