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The aim of study is to evaluate whether the head position facilitates pediatric nasotracheal intubation when using a video-laryngoscope.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sniffing group | Active Comparator | Before intubation, the patient's shoulder is supported by a 5cm pillow to make neck flexion with extension of atlanto-occipital joint, confirming that the external auditory meatus and sternal notch plane are horizontal and aligned. Then, nasotracheal intubation is performed with a reinforced tube (Mallinckrodt Medical, Dublin, Ireland) using video-laryngoscope (AceScope, AceMedical, Seoul, Korea). |
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| Neutral group | Experimental | Before intubation, the patient's head is placed without a pillow on the bed. Then, nasotracheal intubation is performed with a reinforced tube (Mallinckrodt Medical, Dublin, Ireland) using video-laryngoscope (AceScope, AceMedical, Seoul, Korea). |
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| Flexed group | Experimental | Before intubation, the patient's neck is flexed with pads until the chin touches the chest. Then, nasotracheal intubation is performed with a reinforced tube (Mallinckrodt Medical, Dublin, Ireland) using video-laryngoscope (AceScope, AceMedical, Seoul, Korea). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Head position | Other | Before nasotracheal intubation, patient's head is positioned to one of three positions according to assigned group: sniffing, neutral or flexed position. |
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| Measure | Description | Time Frame |
|---|---|---|
| Intubation time | The time between entry of the nasotracheal tube into a nostril and appearance of a carbon dioxide wave on the monitor. | Within 5 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Intubation difficulty scale | The sum of score from seven variables including intubation attempts, supplementary operators, the use of alternative techniques, glottic exposure, the lifting force applied during laryngoscopy, the necessity of applied external laryngeal pressure, and position of vocal cords. From 0 (easiest) to 8 (most difficult) | During intubation |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ajou University School of Medicine | Suwon | Gyeonggi-do | South Korea |
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| ID | Term |
|---|---|
| D018475 | Head-Down Tilt |
| ID | Term |
|---|---|
| D011187 | Posture |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| Epistaxis score | grade 1 (no-epistaxis), grade 2 (mild, blood on the tube only), grade 3 (moderate, blood pooling in the pharynx), or grade 4 (severe: blood impedes intubation) | When removing the video-laryngoscope |
| Numeric rating scale of intubation difficulty | Subjective intubation difficulty from 0 (easiest) to 10 (most difficult) | During intubation |