Boussignac Valve and Fibroptic Intubation in Morbidly Obese Patients, Can it be a Solution?
Keywords
Abstract
Description
All patients will be subjected to a thorough preoperative evaluation including clinical assessment, ECG, Echocardiography, pulmonary function tests and laboratory investigations (CBC, SGOT, SGPT, Albumin, Serum creatinine) and basal arterial blood gases. All patients will be pre-medicated with intravenous infusion of pantoprazole (40 mg) and metoclopramide (10 mg). After pre-oxygenation with 100% oxygen for 5 minutes, anesthesia will be induced using propofol (1-2 mg/kg) preceded by 60 mgs of lidocaine, and rocronium (0.12 mg/kg). Mask ventilation will be maintained while a Boussignac valve is attached between the Y-circuit and the face mask. After full relaxation is achieved (60 second after TOF response disappears), intubation attempt will commence.
Intubation technique:
Patients of both, patients will be put in HELP position to facilitate both ventilation and incubation
- In C group: mask ventilation will be terminated then FOB intubation will be done by experienced anesthist.
- In B group: Mask ventilation will be continued and FOB intubation will be performed from Boussignac valve opening.
Data collection:
Patient demographic data (Age, Weight, height, BMI, ASA status, coexisting diseases) will be collected. Hemodynamic parameters will be r5ecorded at the following points (Preoperative, basal, 1,2,3 minutes after starting intubation attempt).
Time to successful intubation will be documented in seconds (starting from passing of FOB through mouth opening till successful placement of the tube in the trachea). Also, time to glottis visualization and time to carina visualization will be recorded. Number of attempts will be also recorded where unsuccessful attempt will be defined as the need to withdraw FOB outside the patient's mouth (either due to failure to progress or need for ventilation). a desaturation event will be defined as SpO2 less than 94. Also, any procedure-related complication will be documented (hypertension, arrhythmia, spasm, bleeding) Statistical analysis G*power software version 3.1.9.2 was used for sample size calculation. We assumed that using Boussignac valve during FOB intubation can produce a 20% increase in the time to reach patients spo2 of 95% (180±20 sec in previous studies). It was found that 16 patients per was required to achieve a power of 90% with an alpha error of 0.05. additional 4 patients were added to compensate or dropouts making a total sample size of 40 patients.
Data will be collected and tabulated in excel sheet (Microsoft office, 2016). Statistical analysis will be performed using SPSS software version 20. Continuous data will be tested for normality of distribution and presented as mean±SD or median (interquartile range). Statistical differences between the studied groups will be assessed using appropriate statistical tests
Dates
| Last Verified: | 12/31/2017 |
| First Submitted: | 02/04/2017 |
| Estimated Enrollment Submitted: | 02/04/2017 |
| First Posted: | 02/07/2017 |
| Last Update Submitted: | 01/03/2018 |
| Last Update Posted: | 01/07/2018 |
| Actual Study Start Date: | 02/04/2017 |
| Estimated Primary Completion Date: | 12/29/2017 |
| Estimated Study Completion Date: | 12/29/2017 |
Condition or disease
Intervention/treatment
Device: B group
Device: C group
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Experimental: B group Mask ventilation will be continued and fiberoptic intubation will be performed from Boussignac valve opening by an experienced anesthetist. | Device: B group After patients being put in HELP position to facilitate both ventilation and intubation, mask ventilation will be continued and FOB intubation will be performed from Boussignac valve opening. |
| Active Comparator: C group mask ventilation will be terminated then fiberoptic intubation will be done by an experienced anesthetist. | Device: C group After patients being put in HELP position to facilitate both ventilation and incubation, mask ventilation will be terminated then FOB intubation will be done by an experienced anesthetist. |
Eligibility Criteria
| Ages Eligible for Study | 20 Years To 20 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - Morbidly obese patients (BMI above 40kg/m2) scheduled for elective surgery, with age between 20 to 45 years Exclusion Criteria: - unstable ischemic heart disease, uncontrolled systemic hypertension, previous history of difficult intubation and patients with basal oxygen saturation less than 94% |
Outcome
Primary Outcome Measures
1. number of desaturation events [3 minutes after the start of intubation attempt]
