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Recently, left paratracheal pressure was introduced as an alternative method to prevent pulmonary aspiration instead of cricoid pressure. Criocoid pressure is known to worsen glottic visibility when using Pentax.However, the effects of left paratracheal pressure on glottic view when using Pentax are not studied yet. In this study, the subjects are divided into two groups (group I: left paratracheal pressure applied before intubation, group II: conventional cricoid pressure applied before intubation). Investigators will assess the glottic view during intubation using Pentax.
Primary outcome
- Duration of intubation
Secondary outcomes
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Paralaryngeal pressure | Experimental | During the induction of anesthesia, left paratracheal pressure is applied by 30N force with thumb after confirmation of the location of the esophagus using ultrasound. |
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| Cricoid pressure | Active Comparator | During the induction of anesthesia, cricoid pressure is applied by 30N force with three fingers. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Paratracheal pressure | Procedure | To apply paratracheal pressure, the thumb was placed over the left side of the trachea cephalad to the clavicle and medial to the sternocleidomastoid muscle. |
| Measure | Description | Time Frame |
|---|---|---|
| Time to intubation | The duration from when Pentax pass the tooth to confirm the successful intubation using capnography | During anesthesia induction procedure |
| Measure | Description | Time Frame |
|---|---|---|
| The percentage of glottic opening (POGO) score | The percentage of glottic opening (POGO), linear span from the anterior commissure to the interarytenoid notch, 0-100% | During anesthesia induction procedure |
| Cormack-Lehane grade |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ajou University Hospital | Suwon | Gyeonggi-do | 16499 | South Korea |
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Randomized double blinded clinical trial
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The group assignments were sealed in opaque envelopes by a research assistant not involved in the study.
The interventional process covers opaque clothes.
| Cricoid pressure | Procedure | To apply cricoid pressure, the crocoid cartilage was compressed with a single-handed three-finger maneuvre towards the vertebral bodies. |
|
The grade of glottic opening by intubation device (1= Full view of glottis, easy; 4=Neither glottis nor epiglottis seen, difficult)
| During anesthesia induction procedure |
| Intubation difficulty scale (IDS) | The intubation difficulty scale by the sum of seven variables (N1-N7). N1= the number of additional intubation attempts, N2= the number of additional operators, N3= the number of alternative intubation techniques used, N4= the laryngoscopic view, as defined by Cormack and Lehane, N5= the lifting force applied during laryngoscopy, N6= to the necessity to apply external laryngeal pressure to optimize glottic exposure, N7= vocal cord mobility. The IDS score is the sum of N1 through N7. The total IDS score ranges from zero (easy) to infinity (difficult). | During anesthesia induction procedure |
| Intubation difficulty by NRS score | Intubation difficulty by NRS score (0=easy, 10=the most difficult) | During anesthesia induction procedure |
| Success rate in first attempt | Successful intubation in a first attempt | During anesthesia induction procedure |
| Hemodynamic changes | Blood pressure (mmHg) at 4 time points: Baseline, 1 minute after injection of anesthetic drugs, immediately before intubation, and 1 minute after intubation | During anesthesia induction procedure |
| Hemodynamic changes | Heart rate (bpm) at 4 time points: Baseline, 1 minute after injection of anesthetic drugs, immediately before intubation, and 1 minute after intubation | During anesthesia induction procedure |
| Postoperative complications | Postoperative complications including sore throat, hoarseness/dysphonia, or pharyngeal pain | An average of 1 hours after extubation |