Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

Abstract

Background and Aims: Airway management in obese patients is associated with increased risk of difficult airway and intubation. After failed intubation, supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI) may be required. It is uncertain whether SAGFBI is best performed in the ramped versus conventional supine “sniffing air” position. We conducted a feasibility study to evaluate the logistics of positioning, compared glottic views, and evaluated SAGFBI success rates. Methods: We conducted a prospective, pilot study in patients with a body mass index (BMI) 30–40 kg/m 2 undergoing elective operations requiring tracheal intubation. All patients were placed in a ramped position. After induction, a supraglottic airway device (SAD) was inserted. A flexible bronchoscope was inserted into the SAD and a photograph of the glottic view taken. The patient was repositioned to the supine position. A second photograph was taken. SAGFBI was performed. Images were randomised and assessed by two independent anesthetists. Results: Of 17 patients recruited, 15 patients were repositioned successfully. There were no differences in glottic views observed in the two positions. SAGFBI was successful in 92.9% of patients (median time 91.5 s). Haemodynamic changes were noted in 42.7% of patients which resolved spontaneously. Conclusion: Our pilot study was completed within 5 months, achieved low dropout rate and protocol feasibility was established. SAGFBI was successfully and safely performed in obese patients, with a median time of 91.5 s. The time taken for SAGFBI was similar to awake intubation using FBI and videolaryngoscopy. Our study provided preliminary data supporting future, larger-scale studies to evaluate glottic views in the ramped versus supine positions.

Major neurological complications following central neuraxial blockade – A multicentre pilot study in Aurangabad city (MGMA CNB Study)

“…In a pilot feasibility studyrelated to supraglottic airway assisted fibreoptic intubation, the authors assessed only the success criteria but participants’ acceptability for study protocol was not assessed. [ 20 ] Feasibility criteria were not decided a priori . These parameters are mandatory for planning a large study[ 21 22 ] and were considered in the current pilot study.…”

Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study

“…The airway assessment was performed preoperatively by a research team member who was not involved in the endotracheal intubation and assessment of the laryngeal view. The following tests were accomplished; TMHT was measured while the patient was lying supine in a ‘ramped’ position; this position was maintained during intubation,[ 7 ] using a digital depth gauge (INSIZE, China). The TMHT was the vertical distance measured between the anterior border of the thyroid cartilage directly on the thyroid notch and the anterior border of the mentum.…”

Minimising statistical errors in the research domain: Time to work harder and dig deeper!

“…These statistical tests which are seldom reported in IJA need to be incorporated into the analytical methodology at the data collection stage. [ 26 27 ] Additionally, conclusions based on correlation statistics lag behind those on regression statistics due to the inclusion of a single predictor rather than multiple ones. [ 28 ] Nonetheless, a wide variety of statistical tests including the Student's t -test, Chi-square test, Fisher's Exact test, ANOVA, Mann–Whitney test, repeated multivariate ANOVA, Wilcoxon's signed-rank test, ROC curve, univariate and forward stepwise multivariate logistic regression analysis have been applied in the studies published in this issue of the IJA.…”