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Infrared light is applied to the front of the neck of patients for awake flexible optical intubation. The infrared light can be detected by the camera at the tip of the flexible video-bronchoscope. The flexible scope is introduced into the trachea with or without the aid of the blinking infra red light and the ease of placement of the flexible scope is studied.
The investigators study patients for anaesthesia who will need endotracheal intubation and in whom the intubation is predicted to become difficult so that an awake flexible-video-scope-guided intubation is chosen.
Infrared light is applied to the front of the neck of patients for awake flexible optical intubation. The infrared light can be detected by the camera at the tip of the flexible video-bronchoscope. The flexible scope is introduced into the trachea with or without the aid of the blinking infra red light and the ease of placement of the flexible scope is studied.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Infrared guidance first | Experimental | In this arm the infra red guidance is applied to the first passage of the flexible scope to the trachea. The second passage of the flexible scope is without the infrared light |
|
| Infrared guidance last | Active Comparator | In this arm NO infra red guidance is applied to the first passage of the flexible scope to the trachea. The second passage of the flexible scope is with the infrared light as guide |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tracheal intubation by endoscopy with flexible bronchoscope | Procedure | A blinking infrared light source is placed on the anterior neck at the level of the cricothyroid membrane to serve as a guide to facilitate finding the way to the trachea |
| Measure | Description | Time Frame |
|---|---|---|
| Fraction of cases where the blinking light is seen before the vocal cords are seen | The flexible scope is entered into the airway twice, . It is noted from watching the videos of the procedures if the blinking light or the vocal cords are seen first - | 1 day of the procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Fraction of cases where the blinking light is seen from the teeth, the mouth, the pharynx and the larynx and the fra fraction of cases where the vocal cords are seen from the teeth, the mouth, the pharynx and the larynx | The flexible scope is entered into the airway twice, one time with and one time without the blinking light on the front of the neck. It is noted from watching the videos of the procedures if the blinking light or the vocal cords are seen first - and from which anatomical location it is seen. |
| Measure | Description | Time Frame |
|---|---|---|
| Time from the tip of the flexible scope passes the teeth until the blinking light is seen | Time measured from the tip of the flexible scope passes the teeth until the blinking light is seen | 1 day of the procedure |
| Time from the tip of the flexible scope passes the teeth until it is at the level of the mid trachea, trachea rings are seen |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Michael S Kristensen, MD | Rigshospitalet, Denmark | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rigshospitalet, section for anaesthesia for ENT and Maxillofacial surgery, section 3071 | Copenhagen | 2100 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36690598 | Derived | Kristensen MS, Hesselfeldt R, Brinkenfeldt HK, Biro P. Infrared flashing light through the cricothyroid membrane as guidance to awake intubation with a flexible bronchoscope: A randomised cross-over study. Acta Anaesthesiol Scand. 2023 Apr;67(4):432-439. doi: 10.1111/aas.14204. Epub 2023 Feb 2. |
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| 1 day of the procedure |
| Time from the tip of the flexible scope passes the teeth until vocal cords are seen | Time measured from the tip of the flexible scope passes the teeth until the vocal cords are seen | 1 day of the procedure |
Time measured from the tip of the flexible scope passes the teeth until it is at the level of the mid trachea, trachea rings are seen |
| 1 day of the procedure |
| Number of times that the flexible scope is pulled backwards | Counting the number of times that the flexible scope is pulled backwards | 1 day of the procedure |
| Number of times that the flexible scope is reinserted past the teeth | Counting the number of times that the flexible scope is reinserted past the teeth | 1 day of the procedure |
| Number of times that the flexible scope touches the mucosa until the tip is in the mid-trachea | Counting the Number of times that the flexible scope touches the mucosa until the tip is in the mid-trachea | 1 day of the procedure |
| Time from the flexible scope passes the teeth until a carbon dioxide (CO2) curve is seen | Measuring the time from the flexible scope passes the teeth until a CO2 curve is seen on the capnograph | 1 day of the procedure |
| Oxygen saturation | Oxygen saturation measured with pulse oximetry without added oxygen, with nasal oxygen, and the lowest value measured during the whole procedure. | 1 day of the procedure |
| The operators evaluation of the ease of seeing the entrance to the trachea (at the level of the vocal cords) | The operators evaluation of the ease of seeing the entrance to the trachea (at the level of the vocal cords), measured on a scale from 1-10, 1=impossible, 10= very easy) | 1 day of the procedure |
| If the operator means that the blinking infra-red guidance is beneficial for the procedure, | If the operator means that the blinking infra-red guidance is beneficial for the procedure, from 1 to 10, where 1= Not beneficial, 10 = extremely beneficial | 1 day of the procedure |
| If the operator can distinguish the light from trachea fro the surrounding structures? | If the operator can distinguish the light from trachea fro the surrounding structures? On a scale from 1 to 10, 1= Not distinguishable, 10 = Clearly distinguishable | 1 day of the procedure |
| Operators evaluation about the ease of using the blinking light as a guide for insertion of the insertion cord of the flexible scope | Operators evaluation about the ease of using the blinking light as a guide for insertion of the insertion cord of the flexible scope. On a scale from 1-10, 1= Very difficult, 10 = very easy | 1 day of the procedure |
| Fraction pf cases where there is redness of the skin on the anterior neck | Observation of the skin on the anterior neck immediately after removal of the light-source, and one hour after arrival in the post-operative-recovery unit. | 1 day of the procedure |
| Time for ultrasound-guided identification of the cricothyroid membrane and for cannula cricothyroidotomy | Time for ultrasound-guided identification of the cricothyroid membrane and for cannula cricothyroidotomy, measured on video of the procedure | 1 day of the procedure |