Retromolar Route Access With and Without A Retromolar Gap

NCT02611141 | Completed

• 1 other identifier: 1848/2015
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Retromolar Intubation is a successful option for intubation in patients with an existing retromolar gap in the case that the conventional method fails. Therefore the investigators want to test if the retromolar gap is essential for performing the retromolar intubation technique.

Conditions

Airway Management

Keywords

Retromolar Intubation

Outcome Measures

Primary Outcomes (2)

• Cormack & Lehane score (without a backward, upward, rightwards pressure maneuver)

  After ensuring sufficient bag-mask ventilation, the scoring of the vocal cords according to Cormack \& Lehane will be performed at least 2 minutes after administration of the muscle relaxant rocuronium without a backward, upward, rightwards pressure maneuver (=BURB)

  At least 2 minutes after muscle relaxation

• Cormack & Lehane score (with a backward, upward, rightwards pressure maneuver)

  If the Outcome Measure 1 does not reveal a 100% visualization of the vocal cords, a backward, upward, rightwards pressure maneuver (BURP) maneuver will be applied and scored again according to Cormack \& Lehane . Usually each of the two scoring procedures lasts approximately 5-10 seconds.

  Approximately 5-10 seconds after the collection of the Outcome Measure 1

Study Arms (2)

Patient with Retromolar Gap

OTHER

20 patients with a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible.

Procedure: Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane

Patient without a Retromolar Gap

OTHER

20 patients without a retromolar gap between the last erupted molar and the ascending ramus at the right lower mandible.

Procedure: Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane

Interventions

Retromolar laryngoscopy and scoring of the visualisation of the vocal cords according to Cormack & Lehane PROCEDURE

To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack \& Lehane . This score will be assessed at least 2 minutes after muscle relaxation: 1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later): 2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again. Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used.

Patient with Retromolar Gap; Patient without a Retromolar Gap

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• BMI \< 35kg/m2
• Elective surgery
• Absence of at least one molar of the right mandible in arm I (20 patients)

You may not qualify if:

• Emergency patients
• Prevalence of reflux disease
• Toothless patients
• Diaphragmatic hernia
• Patient is not sober
• Ventilation problems during induction of anaesthesia
• Patient with a tracheostomy

Sponsors & Collaborators

• Medical University of Vienna: lead

Study Sites (1)

Medical University of Vienna

Vienna, 1090, Austria

Location

Related Publications (8)

• Ranieri D Jr, Filho SM, Batista S, do Nascimento P Jr. Comparison of Macintosh and Airtraq laryngoscopes in obese patients placed in the ramped position. Anaesthesia. 2012 Sep;67(9):980-5. doi: 10.1111/j.1365-2044.2012.07200.x. Epub 2012 Jun 1.

  PMID: 22670846 BACKGROUND

• De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, Jung B, Chanques G, Jaber S. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014 May;40(5):629-39. doi: 10.1007/s00134-014-3236-5. Epub 2014 Feb 21.

  PMID: 24556912 BACKGROUND

• Scott J, Baker PA. How did the Macintosh laryngoscope become so popular? Paediatr Anaesth. 2009 Jul;19 Suppl 1:24-9. doi: 10.1111/j.1460-9592.2009.03026.x.

  PMID: 19572841 BACKGROUND

• Henderson JJ. Questions about the macintosh laryngoscope and technique of laryngoscopy. Eur J Anaesthesiol. 2000 Jan;17(1):2-5. doi: 10.1046/j.1365-2346.2000.00611.x. No abstract available.

  PMID: 10758437 BACKGROUND

• Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anaesthesia. 2011 Dec;66 Suppl 2:57-64. doi: 10.1111/j.1365-2044.2011.06935.x.

  PMID: 22074080 BACKGROUND

• Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011 Mar;57(3):240-7. doi: 10.1016/j.annemergmed.2010.05.035. Epub 2010 Jul 31.

  PMID: 20674088 BACKGROUND

• Bonfils P. [Difficult intubation in Pierre-Robin children, a new method: the retromolar route]. Anaesthesist. 1983 Jul;32(7):363-7. German.

  PMID: 6614426 BACKGROUND

• Martinez-Lage JL, Eslava JM, Cebrecos AI, Marcos O. Retromolar intubation. J Oral Maxillofac Surg. 1998 Mar;56(3):302-5; discussion 305-6. doi: 10.1016/s0278-2391(98)90103-3.

  PMID: 9496840 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Ao Univ. Prof. Dr. med. univ.

Study Record Dates

• First Submitted: November 7, 2015
• First Posted: November 20, 2015
• Study Start: November 1, 2015
• Primary Completion: July 1, 2017
• Study Completion: July 1, 2017
• Last Updated: March 22, 2018

Record last verified: 2018-03

Locations

AU (1)