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Retromolar Intubation is a successful option for intubation in patients with an existing retromolar gap in the case that the conventional method fails.
Therefore the investigators want to test if the retromolar gap is essential for performing the retromolar intubation technique.
For successful endotracheal intubation an optimal visualisation of the vocal cords is essential. A study comparing retromolar and conventional laryngoscopy showed in patients with an existing retromolar gap, that the retromolar technique is superior for endotracheal intubation especially in patients with a failed 'conventional' intubation attempt. The aim of the following study is to test if a retromolar gap at the right mandible is necessary for the successful performance of the retromolar laryngoscopy technique.
Therefore, 20 patients with and 20 patients without a retromolar gap will be investigated.
The anesthesiologist will visually determine the view of the vocal cords and score it according to Cormack & Lehane. For an improved view a backward, upward, right-ward pressure (BURP) will be performed, if needed, and scored again.
Finally, endotracheal intubation will be performed by the 'conventional' intubation method. If, however, intubation is not possible, then the retromolar technique will be used. In the case that both methods fail, then any (other) intubation method will (can) be used.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient with Retromolar Gap | Other | 20 patients with a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible. |
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| Patient without a Retromolar Gap | Other | 20 patients without a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane | Procedure | To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack & Lehane . This score will be assessed at least 2 minutes after muscle relaxation:
Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used. |
| Measure | Description | Time Frame |
|---|---|---|
| Cormack & Lehane score (without a backward, upward, rightwards pressure maneuver) | After ensuring sufficient bag-mask ventilation, the scoring of the vocal cords according to Cormack & Lehane will be performed at least 2 minutes after administration of the muscle relaxant rocuronium without a backward, upward, rightwards pressure maneuver (=BURB) | At least 2 minutes after muscle relaxation |
| Cormack & Lehane score (with a backward, upward, rightwards pressure maneuver) | If the Outcome Measure 1 does not reveal a 100% visualization of the vocal cords, a backward, upward, rightwards pressure maneuver (BURP) maneuver will be applied and scored again according to Cormack & Lehane . Usually each of the two scoring procedures lasts approximately 5-10 seconds. | Approximately 5-10 seconds after the collection of the Outcome Measure 1 |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University of Vienna | Vienna | 1090 | Austria |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22670846 | Background | Ranieri D Jr, Filho SM, Batista S, do Nascimento P Jr. Comparison of Macintosh and Airtraq laryngoscopes in obese patients placed in the ramped position. Anaesthesia. 2012 Sep;67(9):980-5. doi: 10.1111/j.1365-2044.2012.07200.x. Epub 2012 Jun 1. | |
| 24556912 | Background | De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, Jung B, Chanques G, Jaber S. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014 May;40(5):629-39. doi: 10.1007/s00134-014-3236-5. Epub 2014 Feb 21. |
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| 19572841 | Background | Scott J, Baker PA. How did the Macintosh laryngoscope become so popular? Paediatr Anaesth. 2009 Jul;19 Suppl 1:24-9. doi: 10.1111/j.1460-9592.2009.03026.x. |
| 10758437 | Background | Henderson JJ. Questions about the macintosh laryngoscope and technique of laryngoscopy. Eur J Anaesthesiol. 2000 Jan;17(1):2-5. doi: 10.1046/j.1365-2346.2000.00611.x. No abstract available. |
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| 20674088 | Background | Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. doi: 10.1016/j.annemergmed.2010.05.035. Epub 2010 Jul 31. |
| 6614426 | Background | Bonfils P. [Difficult intubation in Pierre-Robin children, a new method: the retromolar route]. Anaesthesist. 1983 Jul;32(7):363-7. German. |
| 9496840 | Background | Martinez-Lage JL, Eslava JM, Cebrecos AI, Marcos O. Retromolar intubation. J Oral Maxillofac Surg. 1998 Mar;56(3):302-5; discussion 305-6. doi: 10.1016/s0278-2391(98)90103-3. |