AIM and OBJECTIVE:

We aim to compare the Laryngeal exposure rate in Supine vs. 25 Degree vs. 45 Degree back up position using channeled video laryngoscope. 

Primary Objective :

To compare laryngeal exposure rate in Supine vs. 25 Degree vs. 45 Degree back up position, by POGO score and Cormack lehane grading.

Secondary objective:

1. To assess Intubation time
2. To assess first pass attempt rate
3. Use of accessory Intubation aids.
4. To assess the comfort of anaesthesiologist in all three position.

STUDY PROTOCOL:

Ethical consideration: This study will be conducted after obtaining approval ethical committee of GMERS medical college and Hospital, Gotri, Vadodara and topic being registered under CTRI (Clinical trial registry of India.)

Study design: Prospective Randomized , Single Blinded, Observational study

Study setting: Tertiary care teaching hospital (GMERS Medical College and Hospital, Gotri, Vadodara)

Study duration: over 6 months after approval from ethical committee

Study population:  All ASA I and II patients undergoing elective surgery under general anesthesia at GMERS college and hospital, gotri.

Inclusion criteria:

1. Patient aged between 18 to 60 years
2. Either gender
3. All elective surgeries of ASA I and II patients
4. MO more than 3F

5.     MP grade 1,2 and 3

Exclusion criteria:

1.     Patient’s refusal

2.     Any features of Anticipated difficult intubation

3.     Mouth opening less than 3F

4.     BMI more than 30 kg/m2

5.     Previous oral cavity surgery

6.     Pregnant females

7.     Cervical spine injury

METHOD:

Patients will be screened in pre-anesthetic check-up and those fulfilling the eligibility criteria will be informed verbally as well as in written about the study.  After obtaining written and informed consent, willing patients will be enrolled in the study.

Randomization and allocation:

Patients will be randomly divided into three groups by simple randomization. Randomization and allocation will be conducted by a person not involved in the study. The groups are as follows:

Group S: Patients will be intubated in supine position 

Group 25d degree: Patients will be intubated in 25 degree back up

Group 45 degree: Patients will be intubated in 45degree back up

Study Procedures:

•        A thorough pre-anaesthetic evaluation will be done, including airway assessment and necessary laboratory investigations.

•        All patients will be kept nil per oral according to fasting guidelines before the procedure.

•        After receiving the patient in the operative room, a large bore IV cannula will be secured and infusion of IV Ringer lactate will be started.

•         Patients will be placed in assigned position by using a preformed measuring tool.

•        ASA standard monitors, including electrocardiogram, NIBP, pulse oximetry, and capnography will be attached.

•        After pre-oxygenated with 100% oxygen for 3 minutes, patients will be induced under general anesthesia as per institutional protocol.

•        After checking for adequate mask ventilation, injection succinylcholine 1.5 mg/kg body weight will be used to facilitate muscle relaxation.

•         When adequate neuromuscular block is achieved, laryngoscopy will be done in all three groups, using KINGS VISION channeled blade, following which image of glottis was captured.

•        An anesthesiologist blinded to the position will assess the Cormack lehane grade and the percentage of glottic opening (POGO) score using captured images.

•        Intubation time will be noted from insertion of laryngoscope upto the appearance of capnograph on monitor. 

DATA COLLECTION:

The following parameters will be observed and data collected in a tabular form.

1. Number of attempts of intubation
2. Intubation time (from laryngoscopy to appearance of square waveforms in capnography)
3. Anaesthesiologist comfort by Likert satisfaction scale (1–Very dissatisfied,2–Dissatisfied,3–Unsure,4–Satisfied,5–Very satisfied)
4. Use of accessory intubation aids
5. Hemodynamic parameters to be noted at 1,3,5 and 15 min after intubation.

SAMPLE SIZE AND SAMPLING METHOD:

We will be including all the patients posted under general anesthesia for elective surgery full filling study criteria for 6 months and divided equally in three groups in ratio 1:1:1

The results of the observation obtained in each group were tabulated, compiled, and statistically analyzed using ANOVA test and chi-square test.