In GROUP A, the patient’s table will be lowered to the minimum height . A pillow will be retained under the occiput. After 4 minutes of neuromuscular blockade, a experienced anaesthesiologist will position themselves at the head end of the patient to conduct fiberoptic bronchoscopy. The fiberoptic bronchoscope will be held in the experienced anaesthesiologist’s left hand, while the scope sheath will be grasped between the index finger and thumb of the right hand. The mouth will be slightly opened using the ring finger of the right hand. Lingual traction maneuvers will be performed with the assistance of a trained assistant, who will place a gauze over the tongue and retract it manually. The fiberoptic bronchoscope will be gradually inserted into the oral cavity using a midline approach toward the glottis, maintaining the scope in a midline position. The time from the removal of the face mask to the first view of the glottis (T1) will be recorded. As the scope tip approaches the epiglottis, the glottis view will be assessed and graded according to the POGO score In GROUP B , the table height will be minimized, while a pillow remains positioned under the occiput. Following a 4-minute period of neuromuscular blockade, a experienced anaesthesiologist will stand at the head end of the patient to conduct fiberoptic bronchoscopy. The fiberoptic bronchoscope will be held in the anaesthesiologist’s left hand, with the scope sheath gripped between the index finger and thumb of the right hand. The mouth will be slightly opened using the ring finger of the right hand. Cheek pull maneuvers will be executed with the assistance of an assistant, who will place a J shaped stylet in the right cheek and retract it manually. The fiberoptic bronchoscope will be inserted gradually into the oral cavity at the right molar approach toward the glottis, keeping the tip of scope above right molar and advance scope along or just near the right margin of tongue in the right molar approach. The time from the removal of the face mask (To) to the first view of the glottis (T1) will be noted. As the scope tip nears the epiglottis, the glottis view will be assessed and graded according to the POGO score. After T2, in both groups, the tip of the fiberoptic bronchoscope will be advanced beyond the glottis into the trachea. Upon nearing the bifurcation of the trachea, visualization of the carina will be confirmed, and further advancement will be halted. The endotracheal tube will be rail loaded over the fiberoptic bronchoscope, ensuring the tube tip is positioned in the mid-trachea. Subsequently, the fiberoptic bronchoscope will be removed, and the cuff of the endotracheal tube will be adequately inflated. Anaesthesia circuit will be connected immediately to ETT connector followed by controlled mode of mechanical ventilation with tidal volume around 250-300 ml and frequency 20/min. Time taken for appearance of end tidal carbon dioxide (EtCO2) on the capnograph will be noted (T2) and total intubation time will be calculated (T3=T1+T2) The endotracheal tube will be secured in place with tape. Fibre-scopy will be performed to assess and note any injury to the oropharynx & larynx. Surgery will be proceeded as per the requirement of Patient. ◠In both the groups attempt will be abandoned if oxygen saturation falls below 97 percent or time taken for single attempt exceeds 3 minutes. A maximum of three attempts will be taken for successful intubation. If unsuccessful then subsequent alternative airway management technique such as laryngeal mask airway, video-laryngoscopy or direct laryngoscopy will be performed to secure definitive patent airway as per Difficult Airway guidelines. |