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Airway management problems are key drivers for anesthesia-related adverse events. Awake tracheal intubation using flexible bronchoscopy and preserved spontaneous breathing (ATI:FB) is a recommended technique to manage difficult tracheal intubation in anaesthesia, intensive care and emergency medicine. ATI:FB is regarded as the gold standard of tracheal intubation in many scenarios, however there is insufficient data on the patients experience while undergoing this form of airway management. ATI:FB can be facilitated using either a transnasal or transoral route. The study aims to compare patient-centred and operator-focused outcome parameters between these two different approaches with a focus on patient discomfort.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transnasal ATI:FB | Patients undergoing airway management via the transnasal route | ||
| Transoral ATI:FB | Patients undergoing airway management via the transoral route |
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| Measure | Description | Time Frame |
|---|---|---|
| Patient reported discomfort experienced during ATI:FB | recorded on a visual analog scale (1-100; lower values better) | 24 hours after anaesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Patient reported recall of the ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported pain experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) |
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Inclusion Criteria:
Exclusion Criteria:
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Patients scheduled for surgery requiring general anaesthesia at the study center university hospital medical center
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Medical Center Hamburg-Eppendorf | Recruiting | Hamburg | Free and Hanseatic City of Hamburg | 20246 | Germany |
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| 24 hours after airway management |
| Patient reported fear experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported feeling of suffocation experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported dyspnea experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported distress experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported coughing experienced after ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported dry throat experienced after ATI:FB? | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported hoarseness experienced after ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported sleeping problems experienced after ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported occurrence of nightmares experienced after ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | 24 hours after airway management |
| Patient reported preoperative expectation of discomfort to be experienced during ATI:FB | yes/no and on a visual analog scale (1-100; lower values better) | during preoperative assessment |
| Patient reported preoperative fear of airway management | yes/no and on a visual analog scale (1-100; lower values better) | during preoperative assessment |
| First attempt success | number of participants with successful ATI:FB with only one attempt | 1 hour |
| Number of bronchoscopy attempts | Observed during airway management | 1 hour |
| Number of intubation attempts | Observed during airway management | 1 hour |
| Successful ATI:FB | Number of participants with successful ATI:FB | 1 hour |
| Successful bronchoscopy | Number of participants with successful bronchoscopy | 1 hour |
| Successful tube placement | Number of participants with successful tracheal tube placement | 1 hour |
| Conversion from transnasal to transoral bronchoscopy or vice versa | Observed during airway management | 1 hour |
| Conversion to another type of airway management | Observed during airway management | 1 hour |
| Percentage of glottic opening | Grading of the best view obtained during laryngoscopy (%) | 1 hour |
| Glottic view | Grading of the best view obtained using landmarks (6 stages) | 1 hour |
| Time to best glottic view | Recorded during airway management | 1 hour |
| Time to intubation | Recorded during airway management | 1 hour |
| Lowest oxygen saturation | Measured during airway management (%) | 1 hour |
| Endtidal CO2 | First value measured after intubation in mmHg | 1 hour |
| Airway obstructions requiring external manipulation | yes/no | 1 hour |
| Hypoxia | Lowest peripheral oxygen saturation measured by pulsoximetry in % | 1 hour |
| Cardiovascular event requiring intervention (hypotension/bradycardia) | Observed during airway management | 1 hour |
| Cardiovascular event requiring intervention (hypertension, tachycardia) | Observed during airway management | 1 hour |
| Additional manoeuvres and adjuncts | Observed during airway management | 1 hour |
| Airway-related complications | Recorded during airway management | 1 hour |
| Anaesthesia alert card issue | Recorded after airway management | 1 hour |
| Recommendation for future airway management | Recorded after airway management | 1 hour |
| Richmond Agitation-Sedation Scale | Observed during airway management (-5 to 4; lower values indicate deeper sedation) | 1 hour |
| Subjective reporting of difficulty of sedation, topicalisation, bronchoscopy and tube placement | On a visual analog scale (1-100) | 1 hour |
| Preparation time | Recorded during airway management | 1 hour |