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Positioning during the process of tracheal intubation is critical, as optimal positioning can greatly facilitate successful intubation. Many complications can occur as a result of failed intubation, ranging from airway injury, lack of oxygen, with even deaths. Today, the most popular positioning of patients for intubation is in the "sniffing" position. There is however evidence to support that intubation in the bed-up-head-elevated position may be better. In today's technological age, video assisted laryngoscopy (Laryngoscopy is the process of visualizing the vocal cords prior to intubation), a new method where the anaesthetist intubates a patient via aid of an image guided view of the airway, is increasingly popular due to its reliability and superiority to normal intubation. However, it is not widely available, and may suffer from technical breakdowns. The Glidescope is one example of a video laryngoscope, and has been widely researched in the medical literature. In this study, the investigators wish to investigate whether intubation in the bed-up-head-elevated position will be as good as, if not better than Glidescope assisted tracheal intubation, in patients undergoing elective surgery and planned for general anaesthesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bed up head elevated intubation | Active Comparator | Patients positioned in the bed up head elevated position, followed by tracheal intubation |
|
| Glidescope assisted intubation | Active Comparator | Glidescope is used for laryngoscopy, followed by intubation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tracheal intubation | Procedure | Intubation of the trachea with endotracheal tube |
|
| Measure | Description | Time Frame |
|---|---|---|
| Laryngeal exposure | Measured by Percentage of Glottic Opening (POGO) score. A 100% POGO score refers to visualisation of the entire glottic opening from the anterior commissure of the vocal cords to the interarytenoid notch. A POGO score of 0% refers to no visualisation of laryngeal structures. A 100% score is optimal. | Through study completion, period of 1 year |
| Time required for intubation | Measured from the time the tip of the laryngoscope passes through the incisors to the time of the first recorded wave of capnography | Through study completion, period of 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Number of intubation attempts | Through study completion, period of 1 year | |
| Effort during laryngoscopy | Assessed based on a visual analogue scale, with 10 being the strongest effort, and 1 being the least effort required. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Samuel E H Tsan, MD, BMedSc | University of Malaya | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Malaya Medical Centre | Kuala Lumpur | Kuala Lumpur | 59100 | Malaysia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31348051 | Derived | Tsan SEH, Lim SM, Abidin MFZ, Ganesh S, Wang CY. Comparison of Macintosh Laryngoscopy in Bed-up-Head-Elevated Position With GlideScope Laryngoscopy: A Randomized, Controlled, Noninferiority Trial. Anesth Analg. 2020 Jul;131(1):210-219. doi: 10.1213/ANE.0000000000004349. |
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Investigator is blinded to the initial laryngeal exposure during the sniffing position, but is unblinded during assessment of laryngeal exposure in either the bed up head elevated position or glidescope assisted tracheal intubation
| Glidescope assisted tracheal intubation | Device | With the use of the Glidescope video laryngoscope, the trachea will be intubated with the endotracheal tube |
|
| Bed up head elevated tracheal intubation | Device | Use of the Macintosh laryngoscope blade size 3 |
|
| Through study completion, period of 1 year |
| Complications arising from intubation | Incidence of hypoxia, hypotension, or esophageal intubation. Yes/no categories. | Through study completion, period of 1 year |
| Airway trauma | Whether injury occurs to the lips, tongue, teeth, and other structures in the oropharyngeal area. Yes/no categories. | Through study completion, period of 1 year |
| ID | Term |
|---|---|
| D007442 | Intubation, Intratracheal |
| ID | Term |
|---|---|
| D058109 | Airway Management |
| D013812 | Therapeutics |
| D007440 | Intubation |
| D008919 | Investigative Techniques |
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