Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The aim of this work is to investigate the feasibility of using the modified a ramped position for mask ventilation and endotracheal intubation of obese patients in comparison to the traditional ramped position
Adequate conditions for endotracheal intubation and mask ventilation require appropriate positioning of head and neck. The sniffing position had been described as the most appropriate head position for endotracheal intubation. Sniffing position is achieved through two main components: flexion of the neck by 35° (achieved by head elevation) and extension of the head by 15° 2 to have the sternum at the same level of external auditory meatus 34. Sniffing position has the advantage of alignment of the three axes: oral, pharyngeal, and laryngeal axes for reaching the optimal laryngeal visualization.
In obese patients, it is recommended to put the patient in the ramped position (back-up position with the tragus of the ear is at the level of the suprasternal notch) in addition to the sniffing head-and-neck position.
In addition to difficult laryngeal visualization, another problem commonly confronts anesthetists during intubation of obese such as: 1- Impedance to complete mouth opening due to fatty face and neck. 2- Impedance of laryngoscopy by large breasts in females. This problem commonly hinders the intubation process and might lead to serious hypoxia. Most of the positions described in literature were concerned with facilitating laryngeal visualization. No position to the best of our knowledge was applied to aid the introduction of the laryngoscope.
The investigators hypothesized that using a special pillow to achieve a modified ramped position (by slight extension of the neck) at the beginning of the laryngoscopy would enhance mouth opening and bring the breasts away from the laryngoscope. After successful introduction of the laryngoscope in the oral cavity, the head could be manually elevated (if required) to achieve sniffing position.
The aim of this work is to investigate the feasibility of using the aforementioned modified ramped position for intubation of obese females in comparison to the traditional ramped position.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Modified ramped position group | Experimental | In this group, induction of anesthesia will be performed in the modified ramped position. |
|
| Ramped position group | Active Comparator | In this group, induction of anesthesia will be performed in the ordinary ramped position. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Modified ramped position | Other | This position will be achieved using a special pillow. Shoulders will be elevated and neck will be extended to bring the breasts away from the laryngoscopy. The patient will be positioned so that the tip of the last spinous process (C7) will be at the edge of the pillow. The neck will be extended to the most possible range. |
| Measure | Description | Time Frame |
|---|---|---|
| Time for endotracheal intubation | Defined as the time measured in seconds from handling the laryngoscope till confirmation of correct position of endotracheal tube | 5 minutes after induction of general anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Time of laryngoscopy | Time measured in seconds from handling the laryngoscope till insertion of the whole blade length into the oral cavity | 5 minutes after induction of general anesthesia |
| Incidence of difficult laryngoscopy |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Ashraf Rady, Professor | Head of department of anesthesia, Cairo University, Egypt | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ahmed Mohamed Hasanin | Cairo | 11432 | Egypt |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D009765 | Obesity |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
| Ramped position | Other | This position will be achieved by elevation of the shoulders and the head elevation till achieving alignment of sternal notch and external auditory meatus |
|
Defined as "failure to insert the laryngoscope in the oral cavity due to large breast with the need to reposition the patient to insert the laryngoscope"
| 5 minutes after induction of general anesthesia |
| Oxygen saturation | Oxygen saturation measured by pulse oximeter as percentage. | 5 minutes after induction of general anesthesia |
| End-tidal carbon dioxide | End-tidal carbon dioxide measured in mmhg by capnography | 5 minutes after induction of general anesthesia |
| Heart rate | Heart rate measured as number of heart beats per minute | 5 minutes after induction of general anesthesia |
| Incidence of difficult mask ventilation | The incidence of difficult mask ventilation defined as the need for high force or the need for additional assistant for maintenance of adequate ventilation | 5 minutes after induction of general anesthesia |
| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |