Comparison of Tracheal Intubation Using King Vision (Non-channeled Blade) and Tuoren Video Laryngoscopes in Patients With Cervical Spine Immobilization by Manual In-Line Stabilization: A Randomized Clinical Trial.

BACKGROUND: Glottic visualization on cervical immobilization with manual in-line stabilization (MILS) might be challenging in individuals with cervical spine injuries. We compared non-channeled King Vision video laryngoscope (VL) (Ambu GmbH, Bad Nauheim, Germany) with Tuoren video laryngoscope (Henan Tuoren Medical Device, Zhengzhou, China) for endotracheal intubation in patients with cervical spine immobilization. METHODS: A total of 124 patients undergoing elective surgery under general anesthesia were included in this study. After induction of general anesthesia, patients were randomized into two groups (62 each): group K (non-channeled blade of King Vision video laryngoscope) and group T (Tuoren video laryngoscope). Cervical spine immobilization was achieved with manual in-line stabilization. The success of the first pass intubation, the time required to intubate, glottic visualization, and intubation difficulty score (IDS) were recorded. RESULTS: The first-attempt success rate of intubation was 95.2% (59 out of 62 patients) in group K and 90.3% (56 out of 62 patients) in group T, which were comparable. The mean glottic visualization time was significantly less with group T (12.74 ± 6.32 seconds) compared to group K (17.92 ± 4.24 seconds). Intubation time was significantly faster with group K (18.79 ± 5.857 seconds) compared to group T (27.21 ± 8.514 seconds). Both video laryngoscopes provided good grades of glottic visualization. CONCLUSIONS:  We conclude that the performance of the Tuoren video laryngoscope is similar to the King Vision video laryngoscope in terms of first-attempt intubation success rate and glottic visualization score in patients with cervical spine immobilization by manual in-line stabilization. Although glottic visualization time was shorter with Tuoren VL, we could achieve faster intubation with King Vision VL.

Preoperative STOP-BANG questionnaire to predict difficult airway in undiagnosed obstructive sleep apnea patients undergoing elective gynecological surgeries under general endotracheal anesthesia: A prospective observational study.

Background: STOP-BANG questionnaire is an established tool for obstructive sleep apnea (OSA) screening. Its utility in predicting difficult airway has not been evaluated. We intend to assess difficulty in airway management and associated perioperative complications in patients with undiagnosed OSA using the STOP-BANG questionnaire. Materials and Methods: We performed a prospective observational study on 250 patients with the American Society of Anesthesiologists Physical Status Class I-II, aged 18-65 years STOP-BANG score were recorded. Occurrences of difficult mask ventilation (DMV), laryngoscopy, and intubation were assessed using mask ventilation grade, intubation difficulty score intubation difficult score (IDS), and modified Cormack-Lehane grading during induction of anesthesia. Hypoxic events, hemodynamic disturbances, laryngospasm, and bronchospasm were also recorded. Results: Overall, 250 patients completed the study (Group H: n = 102, with STOP-BANG questionnaire ≥3 and Group L: n = 148, with STOP-BANG criteria < 3). A total of 67 (26.8%) cases of DMV and 63 (25.2%) cases of difficult tracheal intubation (DIT) were encountered overall. The proportion of patients with DMV during induction was 59.8% in Group H versus 4.05% in Group L (P < 0.001). A higher incidence of difficult intubation was observed in Group H (56.9% vs. 11.5%, P < 0.001). More patients in Group H had airway complications such as bleeding and injury to the posterior pharyngeal wall or teeth (P < 0.001). Complications such as hypoxia, hypertension, and tachycardia were observed to be higher in Group H (P < 0.001). Conclusion: STOP-BANG questionnaire is an effective bedside preoperative tool that helps in identifying unanticipated difficult airway.

Résumé Contexte: Le questionnaire STOP-BANG est un outil établi pour le dépistage de l'apnée obstructive du sommeil (AOS). Son utilité pour prédire les voies respiratoires n'a pas été évaluée. Nous avons l'intention d'évaluer les difficultés de gestion des voies respiratoires et les complications périopératoires associées chez les patients souffrant d'AOS non diagnostiquée à l'aide du questionnaire STOP-BANG. Matériels et méthodes: Nous avons réalisé une étude observationnelle prospective sur 250 patients avec le score STOP-BANG de classe I-II de l'American Society of Anesthesiologists, âgés de 18 à 65 ans ont été enregistrés. Les occurrences de ventilation au masque difficile (DMV), de laryngoscopie et d'intubation ont été évaluées en utilisant le grade de ventilation au masque, la difficulté d'intubation score (IDS) et le classement de Cormack-Lehane modifié lors de l'induction de l'anesthésie. Événements hypoxiques, troubles hémodynamiques, laryngospasme, et le bronchospasme ont également été enregistrés. Résultats: Au total, 250 patients ont terminé l'étude (Groupe H : n = 102, avec questionnaire STOP-BANG ≥3 et Groupe L : n = 148, avec critère STOP-BANG < 3). Un total de 67 (26,8%) cas de DMV et 63 (25,2%) cas de DIT ont été rencontrés global. La proportion de patients avec DMV lors de l'induction était de 59,8 % dans le groupe H contre 4,05 % dans le groupe L (P < 0,001). Une incidence plus élevée d'intubation difficile a été observée dans le groupe H (56,9 % contre 11,5 %, P < 0,001). Plus de patients du groupe H ont eu des complications des voies respiratoires telles que saignement et lésion de la paroi postérieure du pharynx ou des dents (P < 0,001). Des complications telles que l'hypoxie, l'hypertension et la tachycardie ont été observé comme étant plus élevé dans le groupe H (P < 0,001). Conclusion: Le questionnaire STOP-BANG est un outil préopératoire efficace au chevet du patient qui aide dans l'identification des voies respiratoires difficiles imprévues. Mots-clés: Intubation difficile, ventilation difficile du masque, score de difficulté d'intubation, apnée obstructive du sommeil, questionnaire STOP-BANG.

Is there an optimal place to hold the endotracheal tube during direct laryngoscopy for patients undergoing surgery under general anesthesia? Protocol for a randomized controlled trial.

BACKGROUND: Endotracheal intubation by direct laryngoscopy is a widely performed lifesaving technique. Although there are guidelines for optimal size and depth of insertion of an endotracheal tube (ETT) for successful intubation, there is no consensus on the point at which it should be held along its length. This will arguably affect the time, ease, and success of the technique due to a difference in visualization and torque applied to the ETT after glottic visualization. We aim to compare the effect of 2 different sites of holding the ETT on time to intubation (TTI), intubation difficulty scale (IDS), and complications. METHODS: ASA 1-2 patients (>18 years) posted for surgery under general anesthesia, undergoing supervised intubation by anesthesia trainees (experience < 18 months), will be included. Patients with an anticipated difficult airway or unanticipated difficulty-CL grade 3 or 4 requiring the use of airway adjuncts-will be excluded. Patients will be randomized by a computer-generated number list, and allocation concealed with opaque sealed envelopes. The two sites for holding the ETT will be group 1 at 19 cm and group 2 at 24 cm. ETT marked at the selected site will be handed by the technician once the optimum position of the table, patient, and laryngoscopic view is confirmed by the intubator. The entire procedure will be video recorded. Two blinded assessors will independently review the videos to document the time to intubation and intubation difficulty score. A postoperative sore throat will be recorded. SAMPLE SIZE: To detect a 20% difference in time to intubation between groups with a significance level of 5% and power of 85%, we will need a total of 298 patients. Accounting for data loss, we plan to recruit 180 patients in each group. DISCUSSION: This will be the first study to assess whether the site of holding the tube has any impact on the ease and time taken for intubation. The findings of this study will provide scientific evidence for suggesting an appropriate place for holding the ETT during direct laryngoscopy procedures. TRIAL REGISTRATION: Clinical Trials Registry India CTRI/2019/09/021201.

Goitre-Related Factors for Predicting Difficult Intubation in Patients Scheduled for Thyroidectomy in a Resource-Challenged Health Institution in North Central Nigeria.

BACKGROUND: Airway management problems may arise when intubating patients with goitre scheduled for thyroidectomy. Goitres are not uncommon in sub-Saharan Africa, thyroidectomy being the main treatment. The aim of this study was to determine incidences of difficult intubation (DI), failed intubation (FI) and predictors of DI using a modified intubation difficulty score (IDS). METHODS: One hundred and twenty-five consenting patients with goitre scheduled for thyroidectomy were recruited. Goitre-related factors (GRF) of duration of illness, diagnosis, neck circumference, tracheal deviation and narrowing and retrosternal extension were recorded as well as Mallampati classification and BMI. At intubation, modified IDS was determined for each patient. Patients with modified IDS ≤ 5 were categorized as easy intubation group (E), and those with modified IDS >5 were categorized as difficult intubation group (D). The GRF of all patients in group D were compared with matched patients in group E. RESULTS: Incidence of DI was 13.6% with 2 (1.6%) cases of failed intubation. Comparing groups D and E, duration of illness was 4.28 ± 3.78 years in group D versus 7.44 ± 7.63 years group E, p = 0.1353. Neck circumference was 41.42 ±5.30 cm in group D versus 37.43±2.68 cm in group E, p = 0.0200. Tracheal deviation, narrowing and retrosternal extension, and surgical diagnosis were not significantly different among both groups. CONCLUSION: Incidence of DI was 13.6% and that of FI was 1.6%. Neck circumference was found to be a predictor of difficult intubation in goitre patients scheduled for thyroidectomy using the modified IDS.

Effect of rigid cervical collar on tracheal intubation using Airtraq(®).

BACKGROUND AND AIMS: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq(®) was evaluated. METHODS: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C) and without rigid cervical collar (group NC). The ease of insertion of Airtraq(®) into the oral cavity, intubation time, intubation difficulty score (IDS) were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. RESULTS: Intubation using Airtraq(®) was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24). The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq(®). The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001). The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s) compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003) and bougie was required in 12 (18.5%) and 4 (6.2%) patients in group C and NC, respectively, to facilitate intubation (P = 0.02). The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. CONCLUSION: Tracheal intubation using Airtraq(®) in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS.