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The manufacturer of the mattress has gone bankrupt
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The idea of this study is to demonstrate that the position of the head at a comfort height spontaneously expressed by the patient, between Jackson's amended position or Ramp position, significantly improves the quality of the intubation gesture. This patient position can be easily achieved by placing a compressed air mattress under the patient's trunk - AirPal RAMP ™ mattress.
Thus the investigators can assume that the appropriate positioning and use of a video laryngoscope (McGrathR Mac) places the patient in the best anatomical configuration to breathe and, indirectly to facilitate control of the airways, especially for those with a risk of difficult airway management.
Position for orotracheal intubation The period preceding the administration of anesthetic agents is essential to ensure a satisfactory oxygen supply (pre-oxygenation). Then, once loss of consciousness is achieved, an interface (oral intubation probe) is put in place to allow mechanical ventilation during the procedure. This phase can be marked by a more or less expected difficulty depending on the risk factors presented by the patient. Thus an Arne score> 11 is predictive of a potential difficulty which may lead to an alternative technique being proposed. Simple techniques also exist in the patient setup to reduce the incidence of difficulties. Among them, the placement of a cushion under the head with a slight extension of the head of 20 ° (Jackson's amended position) is recommended because it allows to obtain the alignment of the posterior pharyngeal and glottic spaces. This patient position can be easily achieved by placing a compressed air mattress under the patient's trunk - AirPal RAMP ™ mattress.
This optimization of the position according to the patient, between Jackson's amended position or Ramp position, opens up the prospect of defining an optimal position personalized to each patient. Thus, it can be assumed that the appropriate positioning places the patient in the best anatomical configuration for breathing and, indirectly, to facilitate control of the airways.
Video laryngoscope The use of a video laryngoscope (McGrathR Mac) is becoming widespread in anesthesia, especially for the management of patients at risk of difficult airway management. This device by the video support at the end of the blade provides a better visualization of the glottic orifice.
The hypothesis of this research The idea of this study is to demonstrate that the position of the head at a height of comfort spontaneously expressed by the patient significantly improves the quality of the intubation procedure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Custom | Experimental | patient with installation on an infused airbag until a comfortable position is reached |
|
| Control | No Intervention | Jackson's amended position with placement of a 6 cm high cushion under the patient's head |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| patient with personalized installation with AirPal RAMP™ mattress | Procedure | patient with personalized installation until a comfortable position is reached |
|
| Measure | Description | Time Frame |
|---|---|---|
| the impact of a custom installation versus a conventional Jackson amended installation with a 6-centimeter cushion under the patient's head to facilitate orotracheal intubation | the proportion of orotracheal intubations for which third party assistance is required | 1 day |
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of the effect of patient positioning on the quality of exposure during intubation |
| 1 day |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Morgan LE GUEN, PhD | Suresnes | 92150 | France |
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| Determination of the most frequent complementary resettlement actions |
|
| 1 day |
| Assessment of the quality of manual ventilation before intubation (peroxygenation) |
| 1 day |
| Assessment of the frequency and severity of complications of intubation | The complications of intubation was defined by the pharyngeal pain the day after surgery, dysphonia, an irritative cough reported by the patient and atelectasis. | 2 days |
| Assessment of patient comfort and the doctor's opinion on the technique | The doctor's opinion on the technique was defined by the regard to pre-oxygenation, peroxygenation, and intubation. | 1 day |
| Safety assessment of the technique | Safety was evaluated by the occurrence of a fall of the head, occurrence of a fall of the patient, accidental extubation, the incidence of arterial oxygen desaturation, the lowest arterial oxygen saturation and the perception of difficulty in intubation. | 1 day |