Clinical Research Directory

Sniffing Position vs Left Head Rotation (LeHeR) Maneuver for Glottic View During Direct Laryngoscopy

The left head rotation (LeHeR) maneuver, in which the head of the supine patient is rotated 45° to the left, is a simple, equipment-free technique proposed to improve laryngeal view during laryngoscopy. Published results are conflicting: self-controlled studies report improvement, whereas parallel-group and large cohort studies do not. This prospective, observational, self-controlled study aims to compare the glottic view obtained in the standard sniffing position with that obtained in the 45° LeHeR position in the same adult patients undergoing elective surgery under general anesthesia with direct laryngoscopy. Glottic view will be graded with the modified Cormack-Lehane classification and the Percentage of Glottic Opening (POGO) score. Intubation difficulty, need for additional maneuvers or adjuncts, hemodynamic changes, and airway trauma will also be recorded.

Preoperative Nebulized Lignocaine Versus Nebulized Dexmedetomidine for Blunting the Pressor Response to Laryngoscopy and Intubation in Controlled Hypertensive Patients

This study aims to compare the efficacy of preoperative nebulized lignocaine versus nebulized dexmedetomidine for blunting the pressor response to laryngoscopy and intubation in patients with controlled hypertension under medical treatment.

Can the "Face Index"; an Anthropometric Measurement, Predict Difficult Laryngoscopy and Intubation?

Patient safety is the cornerstone of anesthetic practice, and maintaining adequate respiration represents its most critical initial step. In situations where spontaneous breathing cannot be sustained-such as during general anesthesia-the airway must be mechanically secured. While simple face masks may be sufficient in some cases, endotracheal intubation remains the most reliable method for airway control in conditions associated with respiratory depression. Airway management may be challenging due to various patient-related anatomical factors, including facial and mandibular structure, obesity, limited mouth opening, facial hair, sunken cheeks, wide facial morphology, and a short or muscular neck. These challenges are collectively described as difficult ventilation and difficult intubation (cannot ventilate-cannot intubate), which may occur unexpectedly or be anticipated. A difficult airway is defined as difficulty encountered by a trained anesthesiologist in face mask ventilation, tracheal intubation, or both. Several predictors of difficult airway are widely accepted, such as thyromental and sternomental distances, neck circumference, Mallampati classification, upper lip bite test, mouth opening, and interincisor distance. Thorough preoperative airway evaluation is mandatory, as difficult mask ventilation and failed intubation remain major contributors to anesthesia-related morbidity and mortality. Although numerous studies have examined these predictors, research focusing on facial morphology and anthropometric indices-particularly the face index-is extremely limited. Facial morphology varies considerably among individuals and can be evaluated anthropometrically using simple, noninvasive tools such as a digital caliper. Anthropometric analysis is commonly applied in forensic medicine and reconstructive surgery but has rarely been incorporated into airway assessment. This study aims to introduce face index analysis as a novel predictor of difficult airway alongside conventional methods. By evaluating measurements such as trichion-gnathion distance, total facial index, upper facial index, and nasal index, the study investigates whether airway difficulty can be predicted using a single index value. All measurements are standard, noninvasive, and routinely performed during preoperative assessment.

Artificial Intelligence-Assisted Training for Novice Physicians in Electronic Nasopharyngolaryngoscopy

This study aims to evaluate whether an artificial intelligence-assisted monitoring system can improve the training of novice physicians in electronic nasopharyngolaryngoscopy. The study will compare AI-assisted training with conventional training in terms of post-training examination performance.

Correlation of Neck Dimensions of Airway Evaluation

The goal of this observational study is to evaluate thyromental distance (TMD) and mandibular triangle perpendicular length (MTPL); to know which correlates better with the incisor vallecula distance (IVD). Based on the direction and strength of the correlation measure, a multiple regression equation can then be created to first predict the IVD with external linear measure, and second, based on IVD length prediction, the appropriate laryngoscope blade size can be ascertained.

Effect of High-Flow Nasal Oxygen on Laryngoscopic View

This prospective, multicenter observational study aims to evaluate the effect of different flow rates of high-flow nasal oxygen (HFNO) on the quality of the laryngoscopic view during videolaryngoscopy in adult patients undergoing general anesthesia. Each patient will serve as their own control, with repeated measurements obtained at three different HFNO flow settings (0, 40, and 60 L/min). The study will assess objective and subjective parameters of glottic visualization using standardized scoring systems.

High Flow Oxygen in Patients Undergoing Suspension Laryngoscopy Under General Anesthesia

Patients undergoing suspension laryngoscopy under general anaesthesia have oxygen delivered to their lungs through different methods. Inserting a tube in the trachea is the best means for oxygen delivery. However, it does not allow for optimal visibility of the operated area. Other techniques can be used but have disadvantages with some being associated with serious complications. No consensus exists regarding the best airway management technique for this intervention. The aim of the study is to investigate a new device that delivers oxygen at very high flow through a nasal cannula in patients undergoing suspension laryngoscopy under general anaesthesia. This technique allows the surgeon to have a perfect visualisation of the laryngeal structures while allowing the delivery of oxygen for the lungs. After informed consent, adult patients undergoing suspension laryngoscopy under general anaesthesia in two French hospitals will receive high flow oxygen throughout the procedure. At the end of surgery or, whenever applicable, at the time of technique failure (with a decrease in blood oxygen saturation to less than 92%), blood will be drawn for analysis. All patients will have a thin security catheter inserted in their trachea (the currently used technique in both participating hospitals), allowing for rescue high frequency ventilation if ever the study technique fails. The safety of the device will also be assessed by analysing the blood samples for signs of carbon dioxide accumulation and by collecting any intra or post-operative complications. If the device shows to be effective at maintaining blood oxygenation without significant associated risks, it could be used for other surgical situations where airway management is expected to be difficult.

Comparison of Stress Response Evoked by Conventional Versus Videolaryngoscope

Impact of using video laryngoscopy versus direct laryngoscopy technique in terms of improved hemodynamics post intubation and time taken for intubation.

Effect of Nalbuphine Versus Fentanyl on Hemdoynamic Effects of Laryngoscopy

Participants will undergo routine pre-operative evaluation. An intravenous line will be placed in the recovery area. On arrival in the operating room, standard monitoring (blood pressure, heart rate, oxygen saturation, ECG, breathing monitor, and temperature) will be applied. A central venous catheter and an arterial line will be inserted under local anesthesia using sterile technique. Before anesthesia induction, patients will receive premedication including midazolam and an opioid pain-relief injection given slowly through the vein. General anesthesia will then be induced with etomidate. After adequate sedation, a muscle relaxant (atracurium) will be administered, and the patient will be ventilated with 100% oxygen using a face mask. The breathing tube will then be inserted and correct placement confirmed. During surgery, anesthesia will be maintained with oxygen, sevoflurane gas, and a continuous atracurium infusion. Hemodynamic parameters such as heart rate and blood pressure will be monitored throughout the peri-intubation and intraoperative period.

Do Increasing Preoperative Timing of Single Dexmedetomidine Dose Have an Effect on Stress Response of Laryngoscopy and Intubation?

This study aims to evaluate the effect of increasing preoperative timing of single dexmedetomidine on the stress response of laryngoscopy and intubation.

Oral Melatonin VS Nebulized Dexmedetomidine Premedication on Attenuation of Hemodynamic Response to Direct Laryngoscopy and Tracheal Intubation in Hypertensive Patients

The aim of this study is to compare the efficacy of oral melatonin versus nebulized dexmedetomidine in attenuating the hemodynamic response to direct laryngoscopy and endotracheal intubation in controlled hypertensive patients prepared for general anesthesia

Enhancing Difficult Laryngoscopy Prediction Through A Mixed Scoring System

This study aims to develop a comprehensive airway assessment score including traditional bedside clinical tests and ultrasound measurements with high accuracy in predicting difficult airway, and to validate it through testing it on a large population sample. The main question it aims to answer is: Is the comprehensive scoring system that includes clinical bedside and ultrasound measurements developed to predict difficult airways valid in a large population sample? Adult patients undergoing general anesthesia with American Society of Anesthesiologists (ASA) classification 1-4 will be recruited. Traditional and ultrasound measurements will be collected.

Correlation Between Sedation Depth Monitoring and Reflexes During Intravenous Anesthesia With Dexmedetomidine and Remifentanil in Children Undergoing Direct Laryngoscopy for Surgical Procedures

This study evaluates the correlation between sedation depth monitoring obtained by NeuroSENSE ® NS 701 Monitor and reflexes during intravenous anesthesia in children undergoing direct laryngoscopy for surgical procedures.

Difficult Airways Scores Validation Difficult Laryngoscopy and Mask Ventilation: Prospective and Evaluative Study

Clinical screening tests were included to define a difficult laryngoscopy such as history of difficult or impossible intubation, NC, MMS, retrognathia, protrusion of the upper incisors, TMD, mouth opening, dentition, macroglossia, presence of a beard, UBLT, spine mobility and palm print test for diabetes. Ultrasound airway assessment was performed: Clinical screening tests were included to define a difficult laryngoscopy such as history of difficult or impossible intubation, NC, MMS, retrognathia, protrusion of the upper incisors, TMD, mouth opening, dentition, macroglossia, presence of a beard, UBLT, spine mobility and palm print test for diabetes. Ultrasound airway assessment was performed Three parameters were measured to calculate the scores: Tongue thickness (TT) in coronal plane, Distance from the skin to hyoid bone (SHB), Distance from the skin to the thyrohyoid membrane (STM). Two scores were developed from a study conducted in 2019. The first score, to predict a difficult laryngoscopy, uses two parameters: the modified MALLAMPATI class (MMS) and the STM. A score strictly greater than 2 is predictive of a difficult laryngoscopy. The second score, to predict difficult ventilation, uses four parameters: BMI, NC, TT in coronal plane, and SHB. A score strictly greater than 20 is predictive of difficult ventilation. A well-experienced anesthesiologist performed a direct laryngoscopy and graded it as Cormack-Lehane's grading. Difficulty in intubation and/or mask ventilation was managed according to the 2017 SFAR guidelines.