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To compare two hybrid techniques, flexible bronchoscopy-guided intubation with a video laryngoscope and flexible bronchoscopy-guided intubation with a laryngeal mask, that have recently shown promise as a way to increase first-attempt success rates and reduce complications in children with anticipated difficult intubation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hybrid technique | Experimental |
| |
| Supraglottic airway | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| simultaneous videolaryngoscopy | Device | Two specialists perform tracheal intubation, one using a video laryngoscope to expose the vocal cords and the other using a fiberoptic bronchoscope. |
| Measure | Description | Time Frame |
|---|---|---|
| first attempt intubation success rate | The success rate of a healthcare provider's first attempt to insert a tube into a patient's airway. Intubation is defined as successful if the tube is inserted and capnography is first seen. If the fiberoptic bronchoscope comes out of the mouth, it is a failure. | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| total intubation time (seconds) | Time from when the performer ends mask ventilation to when capnography first appears. | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Number of intubation attempts |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jung-Bin Park, MD | Contact | 0220723664 | 82 | jb4001@snu.ac.kr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul national university hospital | Recruiting | Seoul | 03080 | South Korea |
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| supraglottic airway | Device | After inserting the supraglottic airway, the specialist performs intubation using a fiberoptic bronchoscope through the supraglottic airway. |
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Total number of attempts to intubate, regardless of the method used (failures include bronchoscopy out of the mouth, videolaryngoscope or supraglottic airway out of the mouth, or retrying manual ventilation, even if the method is the same).
| from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| successful tracheal intubation with the allocated method | Whether successful in intubation according to the allocated method or not | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| successful tracheal intubation (Yes or No) | To define and confirm that "successful intubation" occurs when the endotracheal tube is successfully placed inside the trachea, capnography is visible, and surgery can proceed as a result of successful endotracheal intubation. | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Nadir oxygen saturation during intubation (SpO2 value, %) | the minimum oxygen saturation reported during intubation periods | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Oxygen reserve index during intubation (ORiā¢, Rainbow Signal Extraction Technology) | the trends of oxygen reserve index during intubation period per 5 seconds | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| intubation-related complication | Complications associated with intubation (airway injury, esophageal intubation, laryngospasm, bronchospasm, intraoral bleeding, arrhythmia, cardiac arrest). | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| The degree of vocal cord exposure assessed with a flexible bronchoscope. (Modified Cormack-Lehane grade, I/II/III/IV) | Degree of vocal cord exposure, as determined by the Modified Cormack-Lehane grade, when a flexible bronchoscope is inserted by the anesthesiologist. | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |