Comparison of Glottic Views and Intubation Times in the Supine and 25 Degree Back-up Positions

NCT02934347 | Completed Results

• 1 other identifier: BetsiCUHB
• Study Type: observational
• Target: 781
• Locations: 0 countries
• Sites: N/A

Brief Summary

Our hypothesis is that the view of the glottis may be improved by putting all patients requiring intubation in the ramped or back up position while maintaining the classic sniffing position.

Conditions

Elective Surgical Patients

Keywords

Intubation, Back-up position; Glottis, View

Outcome Measures

Primary Outcomes (1)

• The Best Glottic View Obtained During Laryngoscopy

  The best glottic view obtained during laryngoscopy was assessed using the Cormack and Lehane classification by the anaesthetist performing the laryngoscopy. The Cormack and Lehane classifies glottic views as follows: Grade 1: Most of the glottis is visible, Grade 2: At best almost half of the glottis is seen, at worst only the posterior tip of the arytenoids is seen., Grade 3: Only the epiglottis is visible, Grade 4: No laryngeal structures are visible.

  The view of the glottis was measured once while the patient was being intubated

Secondary Outcomes (3)

• The Number of Attempts at Both Laryngoscopy and Tracheal Intubation

  Once at intubation

• The Use of Ancillary Equipment

  Once at intubation

• The Time Between the Beginning of Laryngoscopy and Detection of Carbon Dioxide on the End-tidal Carbon Dioxide Monitor

  Once at intubation

Study Arms (2)

Supine

A baseline group of adult patients who required intubation as part of their routine anaesthesia who were intubated in the standard horizontal sniffing position.

Back-up

A subsequent group of similar the patients who had their anaesthesia induced and tracheas intubated in a 25 degree back-up position achieved by flexion of the operating table at the hips

Procedure: 25 degree back-up position

Interventions

25 degree back-up position PROCEDURE

To test whether a 25 degree back-up position improves laryngeal views and makes intubation easier compared to the standard horizontal position

Back-up

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients who required intubation as part of their routine anaesthesia

You may qualify if:

• Adult surgical patients who required intubation as part of their routine anaesthesia

You may not qualify if:

• Patients less than 18 years old,
• Patients recognised to have difficult airways where an alternative method of intubation (e.g. fibre optic) was the method of choice,
• Patients undergoing emergency surgery where patient positioning and data collection might cause delay (e.g. exsanguinating patients) or where the supine position is not optimal (e.g. brisk bleeding into the upper airway),
• Patients requiring rapid sequence induction of anaesthesia

Sponsors & Collaborators

• Betsi Cadwaladr University Health Board: lead

Related Publications (12)

• Adnet F, Baillard C, Borron SW, Denantes C, Lefebvre L, Galinski M, Martinez C, Cupa M, Lapostolle F. Randomized study comparing the "sniffing position" with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology. 2001 Oct;95(4):836-41. doi: 10.1097/00000542-200110000-00009.

  PMID: 11605921 BACKGROUND

• Bannister FB, Macbeth RG. Direct laryngoscopy and tracheal intubation. Lancet 1944; 2: 651-4

  BACKGROUND

• Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth. 2010 Nov;105(5):683-90. doi: 10.1093/bja/aeq239. Epub 2010 Sep 15.

  PMID: 20846964 BACKGROUND

• Jackson C. Bronchoscopy and Esophagoscopy: A Manual of Peroral Endoscopy and Laryngeal Surgery. Philadelphia and London: WB Saunders; 1922

  BACKGROUND

• Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007 Oct;99(4):581-6. doi: 10.1093/bja/aem095. Epub 2007 Jul 4.

  PMID: 17611252 BACKGROUND

• Lee HC, Yun MJ, Hwang JW, Na HS, Kim DH, Park JY. Higher operating tables provide better laryngeal views for tracheal intubation. Br J Anaesth. 2014 Apr;112(4):749-55. doi: 10.1093/bja/aet428. Epub 2013 Dec 18.

  PMID: 24355831 BACKGROUND

• Rao SL, Kunselman AR, Schuler HG, DesHarnais S. Laryngoscopy and tracheal intubation in the head-elevated position in obese patients: a randomized, controlled, equivalence trial. Anesth Analg. 2008 Dec;107(6):1912-8. doi: 10.1213/ane.0b013e31818556ed.

  PMID: 19020138 BACKGROUND

• Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions. Obes Surg. 2004 Oct;14(9):1171-5. doi: 10.1381/0960892042386869.

  PMID: 15527629 BACKGROUND

• Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005 Nov;60(11):1064-7. doi: 10.1111/j.1365-2044.2005.04374.x.

  PMID: 16229689 BACKGROUND

• Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, Laurie CP, O'Brien PE. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005 Jun;102(6):1110-5; discussion 5A. doi: 10.1097/00000542-200506000-00009.

  PMID: 15915022 BACKGROUND

• Lebowitz PW, Shay H, Straker T, Rubin D, Bodner S. Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals. J Clin Anesth. 2012 Mar;24(2):104-8. doi: 10.1016/j.jclinane.2011.06.015. Epub 2012 Feb 1.

  PMID: 22301204 BACKGROUND

• Reddy RM, Adke M, Patil P, Kosheleva I, Ridley S; Anaesthetic Department at Glan Clwyd Hospital. Comparison of glottic views and intubation times in the supine and 25 degree back-up positions. BMC Anesthesiol. 2016 Nov 16;16(1):113. doi: 10.1186/s12871-016-0280-4.

  PMID: 27852241 DERIVED

Limitations and Caveats

The present study was under-powered to detect small differences in glottic views. There would be additional variation as the results were reported by the whole Anaesthetic Dept rather than a few investigators

Results Point of Contact

• Title: Dr Raj Reddy
• Organization: Glan Clwyd Hospital, Betsi Cadwaladr University Health Board

Rajashekhar.Reddy@wales.nhs.uk

01745 583910

Study Officials

• Raj M Reddy, FRCA

  Anaesthetic Department, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Consultant Anaesthetist

Study Record Dates

• First Submitted: October 13, 2016
• First Posted: October 17, 2016
• Study Start: February 1, 2012
• Primary Completion: November 1, 2014
• Study Completion: January 1, 2015
• Last Updated: May 11, 2017
• Results First Posted: March 30, 2017

Record last verified: 2017-04

Data Sharing

• IPD Sharing: Will share