Difficult Pediatric Airway Management: A Randomized Trial Comparing Laryngeal Mask Airway, Video‐Assisted, and Direct Laryngoscopy

Ambrosio, A; Perez, Colleen; Byrnes, Chelsie; Gaconnet, Cory; Cornelissen, Christopher; Brigger, Matthew T.

doi:10.1177/0194599814541627a227

Cited by 2 publications

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“…However, patient intubation in a difficult airway requires specialized technical skills, availability of appropriate equipment, and proper assessment of the clinical situation and priorities [ 1 ]. Consequently, experienced and inexperienced physicians or allied health professionals routinely encounter difficult intubation situations in the hospital and prehospital settings [ 2 ]. Moreover, predicting airway management-related difficulties remains a challenge and cause of frustration among anesthesiologists [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial

Chan¹,

Jularbal²,

Mapili³

2023

Interact J Med Res

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Background Tracheal intubation is a life-saving intervention, and optimizing the patient’s head and neck position for the best glottic view is a crucial step that accelerates the procedure. The left head rotation maneuver has been recently described as an innovative alternative to the traditional sniffing position used for tracheal intubation with marked improvement in glottic visualization. Objective This study compared the glottic view and intubating conditions in the sniffing position versus left head rotation during direct laryngoscopy. Methods This randomized, open-label clinical trial enrolled 52 adult patients admitted to Baguio General Hospital and Medical Center from September 2020 to January 2021 for an elective surgical procedure requiring tracheal intubation under general anesthesia. Intubation was done using a 45° left head rotation in the experimental group (n=26), while the control group (n=26) was intubated using the conventional sniffing position. Glottic visualization and intubation difficulty with the two procedures were assessed using the Cormack-Lehane grade and Intubation Difficulty Scale, respectively. Successful intubation is measured by observing a capnographic waveform in the end-tidal CO2 monitor after placement of the endotracheal tube. Results There was no statistically significant difference in the Cormack-Lehane grade, with 85% (n=44) of patients classified under grades 1 (n=11 and n=15) and 2 (n=11 and n=7) in the left head rotation and sniffing position groups, respectively. In addition, there were no statistically significant differences in the Intubation Difficulty Scale scores of patients intubated with left head rotation or sniffing position; 30.7% (n=8) of patients in both groups were easily intubated, while 53.8% (n=14) in left head rotation and 57.6% (n=15) in sniffing position groups were intubated with slight difficulty. Similarly, there were no significant differences between the 2 techniques in any of the 7 parameters of the Intubation Difficulty Scale, although numerically fewer patients required the application of additional lifting force (n=7, 26.9% vs n=11, 42.3%) or laryngeal pressure (n=3, 11.5% vs n=7, 26.9%) when intubated with left head rotation. The intubation success rate with left head rotation was 92.3% versus 100% in the sniffing position, but this difference was not statistically significant. Conclusions Left head rotation produces comparable laryngeal exposure and intubation ease to the conventional sniffing position. Therefore, left head rotation may be an alternative for patients who cannot be intubated in the sniffing position, especially in hospitals where advanced techniques such as video laryngoscopes and flexible bronchoscopes are unavailable, as is the case in this study. However, since our sample size was small, studies with a larger study population are warranted to establish the generalizability of our findings. In addition, we observed inadequate familiarity among anesthesiologists with the left head rotation technique, and the intubation success rate may improve as practitioners attain greater technical familiarization. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN)ISRCTN23442026; https://www.isrctn.com/ISRCTN23442026

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Section: Introductionmentioning

confidence: 99%

Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial

Chan¹,

Jularbal²,

Mapili³

2023

Interact J Med Res

View full text Add to dashboard Cite

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Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial (Preprint)

Chan¹,

Jularbal²,

Mapili³

2022

Preprint

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BACKGROUND Tracheal intubation is a life-saving intervention not only for physicians but also for allied health workers. Optimizing the patient's head and neck position for the best glottic view is a crucial step that accelerates tracheal intubation. The left head rotation maneuver has been recently described as an innovative approach to tracheal intubation with marked improvement in glottic visualization and can be an alternative before proceeding to a surgical airway. OBJECTIVE This study aimed to compare the glottic view and intubating conditions in the sniffing position versus left head rotation during direct laryngoscopy. METHODS This randomized, open-label clinical trial enrolled fifty-two adult patients admitted to the Baguio General Hospital & Medical Center from September to January 2021 for an elective surgical procedure requiring tracheal intubation under general anesthesia. Intubation was done using a 45-degree left head rotation in the experimental group, while the control group was intubated using the conventional sniffing position. Glottic visualization and intubation difficulty with left head rotation and sniffing position were assessed using Cormack-Lehane Grade and Intubation Difficulty Scale, respectively. Successful intubation is measured by observing a capnographic waveform in the end-tidal CO2 monitor after placement of the endotracheal tube. RESULTS There was no significant statistical difference in the clinicodemographic characteristics between the two groups. There was no significant difference in the Cormack-Lehane Grade (P=.45), with the majority of patients classified under Grade 1 (21% in left head rotation and 28% in sniffing position) and Grade 2 (21% in left head rotation and 13% in sniffing position). Also, there were no statistically significant differences (P=.85) in the Intubation Difficulty Scale scores of patients intubated with left head rotation or sniffing position; 17.3% and 15.4% of patients were easily intubated with left head rotation and sniffing position, respectively while slight difficulty was noted with most patients with no between-group differences (26.9% in left head rotation and 30.8% in sniffing position). Greater than one attempt at intubation, use of an alternative technique such as a stylet, and the need for more than one operator were commonly used with left head rotation. The intubation success rate was 100% (26/26) in the sniffing position, while the success rate was 92% (24/26) with left head rotation. CONCLUSIONS Sniffing position provided a higher intubation success rate but with comparable laryngeal exposure and intubation ease to left head rotation. However, since our sample size was small, studies with a larger study population are warranted to establish the generalizability of our findings. In addition, we observed inadequate familiarity among anesthesiologists with the left head rotation technique, and the intubation success rate may improve as practitioners attain greater technical familiarization. CLINICALTRIAL ISRCTN23442026

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Difficult Pediatric Airway Management: A Randomized Trial Comparing Laryngeal Mask Airway, Video‐Assisted, and Direct Laryngoscopy

Cited by 2 publications

References 0 publications

Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial

Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial

Left Head Rotation as an Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial (Preprint)

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