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Among advanced intubation equipment for difficult intubation, a lighted stylet (lightwand) is a widely used equipment in cervical immobilized patients. However, a lightwand, which is used blind, is difficult to make midline positioning and can increase airway complications and hemodynamic changes. In contrast, videolaryngoscope can view vocal cord indirectly through camera, however, it requires cervical movement. Therefore, investigator hypothesized that the combined use of video-laryngoscope and lightwand for intubation can improve the efficacy of intubation compared to the use of lightwand alone in cervical immobilized patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| video-laryngoscope guided lightwand | Experimental |
| |
| lightwand | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Video-laryngoscope guided lightwand | Device | After anesthetic induction,the difficult airway is simulated by wearing a semi-hard neck collar. For intubation, video-laryngoscope is inserted into the oral cavity ntil the epiglottis tip was visible without lifting the epiglottic vallecula. Then, the endotracheal tube with lightwand is inserted toward the midline under the epiglottis and the intubation is performed looking the transilluminated light of lightwand. |
| Measure | Description | Time Frame |
|---|---|---|
| The success rate of intubation | Confirm the success intubation through end-tidal carbon dioxide on a capnography | Within 90 sec after insertion of lightwand or video-laryngosocpe into oral cavity. |
| The duration of intubation | Define as the duration between insertion of lightwand or video-laryngoscope to oral cavity and removal all intubating devices from oral cavity. | Within 90 sec after insertion of lightwand or video-laryngosocpe into oral cavity. |
| Measure | Description | Time Frame |
|---|---|---|
| number of intubation trial and scooping movements | The number of intubation tiral and scooping movements during intubation | during intubation time, intubation attempts allows maximum 3 times, within 90 sec in each time |
| Blood pressure change |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine | Seoul | 03722 | South Korea |
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| lightwand alone | Device | After anesthetic induction,the difficult airway is simulated by wearing a semi-hard neck collar. Then, the endotracheal tube with lightwand is inserted and the intubation is performed with conventional method (blind technique by confirming transillumination). |
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The difference between maximum mean blood pressure and minimum blood pressure
| from start of intubation to 5minute after intubation |
| Injuries of oral cavity | Check any blood in lips, teeth, endotracheal cuff, and oral cavity | at immediate after intubation and extubation |
| Postoperative hoarseness | Check "Yes or No" through questioning the patient | at 1hr after PACU arrival and 24hr after operation |
| Postoperative sore throat | Check using visual analog scale (0-100 points) | at 1hr after PACU arrival and 24hr after operation |
| Heart rate change | The difference between maximum heart rate and minimum minimum heart rate | from start of intubation to 5minute after intubation |