An MRI Study of the Sniffing, Neutral and Extended Head and Neck Positions

NCT05002790 | Completed Results

• 1 other identifier: 282078
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

The traditional method of tracheal intubation requires the insertion of a laryngoscope into the oral cavity and directly visualisation of the glottis. The traditional head position called the sniffing the morning air position; consisting of lower cervical flexion and extension of the atlanto-occipital joint is commonly used to facilitate tracheal intubation in this manner by aligning the oral axes and providing the operator a view of the glottis. With the advancement of technology, has seen videolaryngoscopes (VL) developed to ease tracheal intubation. With VL, the glottis is seen through a camera connected to a viewing screen either attached to the top of the laryngoscope or connected to a camera screen by cable. One of the main drawbacks with VL is that a good view of the glottis is seen on the screen, but it can be difficult to pass the tracheal tube through the glottis in comparison to the traditional intubation technique described above. One of the main factors the authors suggest is that VL-assisted intubation requires a head and neck position that is different to the sniffing the morning air position. This study aims to assess the oral axes in three different head and neck positions under MRI to assess which positions improve axial alignment the most.

Conditions

Intubation, Intratracheal

Keywords

Airway management; Videolaryngoscopy; Hyperangulated blades

Outcome Measures

Primary Outcomes (1)

• Angle A Measured on MRI

  To determine which patient head and neck positioning significantly improves the angle A. It is defined as the angle between the tracheal axis (TA) and laryngeal axis (LA)

  Each subject will undergo 3 MRI scans. Angle A will be measured on each scan at the end of all the scans performed that day. The angles will be measured by 2 investigators.

Secondary Outcomes (1)

• Angle B, C, D and E Measured Using MRI

  Each subject will undergo 3 MRI scans. The angles will be measured on each scan at the end of the scanning performed that day. The angles will be measured by 2 investigators.

Study Arms (1)

Data collection

EXPERIMENTAL

All 20 anticipated subjects to be scanned under MRI, with data collected and analysed together

Diagnostic Test: Data collection group

Interventions

Data collection group DIAGNOSTIC_TEST

Magnetic resonance imaging (MRI) allows measurement of the axes described to suggest which head and neck position would provide best anatomical alignment to reduce anterior impingement. All the MRI scans will be conducted using 3.0 Tesla (Optima 750w, GE Medical, Milwaukee, WI, USA) using the cervical spine section of the coil. T2-weighted images in the sagittal plane will be acquired using a fast recovery fast spin echo (FRFSE) technique. The scans will take around two and half minutes and a member of the anaesthetic investigator team will be present to facilitate positional changes and maintain consistency. MRI scanning will be performed in following 3 head and neck positions: Neutral position, Sniffing position and the Extension position.

Data collection

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Able to provide consent
• Volunteers, UHCW staff, aged \> 18 years
• Medically able and willing undertake MRI scanning.
• Should pass the MRI safety check list to enter the MRI suite. All participants will complete an MR safety questionnaire immediately prior to their MR scan

You may not qualify if:

• Unable to provide consent
• Not willing to have MRI scan or unable to undergo MRI scanning
• Known difficult intubation, Restricted or neck extension not possible or presence of arthritis of cervical spine.
• For MRI safety reasons all participants with a cardiac pacemaker or other electronic implants will be excluded from the study.

Sponsors & Collaborators

• University Hospitals Coventry and Warwickshire NHS Trust: lead

Study Sites (1)

University Hospitals Coventry & Warwickshire NHS Trust

Coventry, West Midlands, CV2 2DX, United Kingdom

Location

Related Publications (14)

• Abramson ZR, Susarla S, Tagoni JR, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy. J Oral Maxillofac Surg. 2010 Feb;68(2):363-71. doi: 10.1016/j.joms.2009.09.086. Epub 2010 Jan 15.

  PMID: 20116709 BACKGROUND

• Adnet F, Borron SW, Dumas JL, Lapostolle F, Cupa M, Lapandry C. Study of the "sniffing position" by magnetic resonance imaging. Anesthesiology. 2001 Jan;94(1):83-6. doi: 10.1097/00000542-200101000-00017.

  PMID: 11135726 BACKGROUND

• 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

• Aziz MF, Bayman EO, Van Tienderen MM, Todd MM; StAGE Investigator Group; Brambrink AM. Predictors of difficult videolaryngoscopy with GlideScope(R) or C-MAC(R) with D-blade: secondary analysis from a large comparative videolaryngoscopy trial. Br J Anaesth. 2016 Jul;117(1):118-23. doi: 10.1093/bja/aew128.

  PMID: 27317711 BACKGROUND

• Brindley PG, Simmonds MR, Needham CJ, Simmonds KA. Teaching airway management to novices: a simulator manikin study comparing the 'sniffing position' and 'win with the chin' analogies. Br J Anaesth. 2010 Apr;104(4):496-500. doi: 10.1093/bja/aeq020. Epub 2010 Feb 18.

  PMID: 20167582 BACKGROUND

• Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth. 2005 Feb;52(2):191-8. doi: 10.1007/BF03027728.

  PMID: 15684262 BACKGROUND

• El-Orbany M, Woehlck H, Salem MR. Head and neck position for direct laryngoscopy. Anesth Analg. 2011 Jul;113(1):103-9. doi: 10.1213/ANE.0b013e31821c7e9c. Epub 2011 May 19.

  PMID: 21596871 BACKGROUND

• Horton WA, Fahy L, Charters P. Defining a standard intubating position using "angle finder". Br J Anaesth. 1989 Jan;62(1):6-12. doi: 10.1093/bja/62.1.6.

  PMID: 2917111 BACKGROUND

• Greenland KB, Edwards MJ, Hutton NJ. External auditory meatus-sternal notch relationship in adults in the sniffing position: a magnetic resonance imaging study. Br J Anaesth. 2010 Feb;104(2):268-9. doi: 10.1093/bja/aep390. No abstract available.

  PMID: 20086071 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

• 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

• Meisami T, Musa M, Keller MA, Cooper R, Clokie CM, Sandor GK. Magnetic resonance imaging assessment of airway status after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Apr;103(4):458-63. doi: 10.1016/j.tripleo.2006.07.006. Epub 2006 Oct 27.

  PMID: 17395062 BACKGROUND

• Mendonca C, Ungureanu N, Nowicka A, Kumar P. A randomised clinical trial comparing the 'sniffing' and neutral position using channelled (KingVision(R) ) and non-channelled (C-MAC(R) ) videolaryngoscopes. Anaesthesia. 2018 Jul;73(7):847-855. doi: 10.1111/anae.14289. Epub 2018 Apr 16.

  PMID: 29660807 BACKGROUND

• Stuck BA, Kopke J, Maurer JT, Verse T, Kuciak G, Duber C, Hormann K. Evaluating the upper airway with standardized magnetic resonance imaging. Laryngoscope. 2002 Mar;112(3):552-8. doi: 10.1097/00005537-200203000-00026.

  PMID: 12148870 BACKGROUND

Results Point of Contact

• Title: Cyprian Mendonca
• Organization: University Hospitals Coventry &Watwickshire NHS Trust

cyprian.mendonca@uhcw.nhs.uk

02476964000

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Single group assignment Controlled trial without randomisation

Study Record Dates

• First Submitted: August 4, 2021
• First Posted: August 12, 2021
• Study Start: August 5, 2021
• Primary Completion: October 21, 2021
• Study Completion: October 21, 2021
• Last Updated: August 28, 2024
• Results First Posted: August 28, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)