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This study will include pregnants who preferred to undergo general anesthesia for elective cesarean section. Ramped and sniffing positions of pregnant women during ventilation and intubation will be compared. The aim of this study is to investigate which position provides easier and faster intubation in pregnant women for cesarean section.
Estimates of the frequency of difficult and failed intubation in the obstetric population vary within a wide range of percentiles. Several times higher than those reported for the general surgery population. Functional Residual Capacity decreases by 10% - 25% in Pregnant women. Pregnant women are more susceptible to hypoxia as a result of this decline, which also encourages intubation to occur more rapidly. Intubation success and shortening of intubation time have improved positively with videolaryngoscopes. On the other hand, the position of the patient during intubation contributes to the speed and success of intubation. It has been shown that intubation is faster and first-pass success is higher in the ramped position in morbidly obese patients.This study will compare the effectiveness of ramp and sniffing positions on intubation time and success in obese patients and pregnant women with similar physical changes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ramped position group | Active Comparator | This position will be achieved by elevation of the shoulders and the head elevation till achieving alignment of sternal notch and external auditory meatus |
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| Sniffing position group | Sham Comparator | This position will be achieved by placing a 7 cm pillow under the occiput. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ramped position group | 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 |
| Measure | Description | Time Frame |
|---|---|---|
| 1. Total intubation time | Total intubation time will be calculated by adding up the laryngoscopy time and tube insertion time. | 5 minutes after induction of general anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of difficult intubation | The Intubation Difficulty Scale (IDS) will be used to define the intubation difficulty. Intubation is considered easy if IDS=0, slight difficulty if 0 < IDS < 5, Moderate to Major Difficulty if 5 < IDS, impossible if IDS = ∞. | 5 minutes after induction of general anesthesia |
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Inclusion Criteria:
Exclusion Criteria:
Since intubation time for cesarean section will be evaluated, only female patients will be studied.
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| Name | Affiliation | Role |
|---|---|---|
| Muhammet Korkusuz, MD | Karamanoğlu Mehmetbey University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karaman Training and Research Hospital | Karaman | 70200 | Turkey (Türkiye) |
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There are two group;
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Due to the nature of the study, patients and care providers will be blind
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| Sniffing position group | Other | This position will be achieved by placing a 7 cm pillow under the occiput. |
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| Incidence of difficult mask ventilation |
The Warters Scale will be used to define the mask ventilation difficulty. Difficult mask ventilation is defined as a score ≥ 4 on the Warters scale |
| 5 minutes after induction of general anesthesia |
| Laryngoscopy time | The timing measurements will begin when the videolaryngoscope blade first passes between the teeth and will end when the best glottic view is obtained on the videolaryngoscopy monitor. | 5 minutes after induction of general anesthesia |
| Tube insertion time | The timing measurements will begin when the endotracheal tube first passes between the teeth and ended when the tube passes through the glottis. | 5 minutes after induction of general anesthesia |
| Complications related to intubation | A postoperative follow-up assessment will be performed approximately 4 hr after surgery by a co-investigator blinded to the intubation position to evaluate the presence and severity of sore throat, any changes in voice, trauma to the lip, tongue, palate, or teeth. | postoperative 4th hour |