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Hypertensive PatientsNCT03316443

A Comparative Study of Glidescope Versus Macintosh Laryngoscope in Adult Hypertensive Patients

A study testing Glidescope and Macintosh in people with Hypertensive Patients, run by Mansoura University at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Hemodynamic response to laryngoscopy and tracheal intubation remain of utmost concern in anesthesia practice. Sympathetic stimulation and adverse physiologic events could be tolerated by healthy individuals, but they may be detrimental in hypertensive patients. Read more about this study

Who is it for?
Ages 20 to 80 years
Conditions the study is for
Hypertensive Patients
What is being tested?
Glidescope and Macintosh
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
1 siteEgypt
Study dates
1 Nov 2017to 1 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients aged more than 20 year old.
  • Patients classified by the American society of anesthesiologist as 2 or 3 with controlled hypertension.
  • Patients with body mass index less than 35.
  • Mallampati score 1 or 2, thyromental distance more than 4 cm and central incisor interdistance more than 3 cm will included.

Who cannot join

  • Patient refusal.
  • Patient with uncontrolled hypertension (patients diagnosed as uncontrolled hypertension if they have history of hypertension and systolic blood pressure after 3 measures after admission exceeding 150 mmHg despite of regular antihypertensive therapy).
  • Patient with major cardiac diseases (e.g cardiomyopathy).
  • Patient with cerebrovascular accidents.
  • Patient with history of difficult intubation.
  • Patients at risk of aspiration who require rapid sequence induction.

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • Mansoura faculty of medicine

    Al Mansurah, Dakahlia Governorate, 050

Other trials in Egypt

About this study

Official title: A Prospective Randomized Comparative Study of Glidescope Versus Macintosh Laryngoscope in Adult Hypertensive Patients

Hemodynamic response to laryngoscopy and tracheal intubation remain of utmost concern in anesthesia practice. Sympathetic stimulation and adverse physiologic events could be tolerated by healthy individuals, but they may be detrimental in hypertensive patients.

The magnitude of hemodynamic response of intubation is related to the degree of manipulation of the oropharyngeo-laryngeal structures. Unlike Macintosh laryngoscope,Glidescope is a device that does not require alignment of oropharyngeal axis to visualize the glottis.It needs less upward lifting force with less manipulation of pharyngeal structures during the intubation.

It was reported that Glidescope had no significant advantage over Macintosh in attenuating circulatory response to endotracheal intubation in normotensive patients.Till now no clinical trials investigate the hemodynamic effects of Glidescope in hypertensive patients.The investigators hypothesized that the Glidescope will induce less hemodynamic changes among hypertensive patients during endotracheal intubation.So the study was designed to compare effects of Glidescope versus Macintosh laryngoscope in hypertensive patients with special regard to hemodynamics and intubation conditions.

Read the detailed description

This is prospective randomized study will performed at Urology and Nephrology Centre, Mansoura University after approval from Institutional Research Board, Mansoura University.Patients were interviewed and written informed consent will be obtained from selected patients scheduled for different urological surgeries.

Eligible adult patients will be randomly allocated by a computer-generated randomization sequence into 2 equal groups:

Macintosh group: 45 patients will be intubated by Macintosh laryngoscope(Group M).

Glidescope group: 45 patients will be intubated by Glidescope(Group G).

Preoperative assessment:

All patients will be assessed preoperatively by:

  1. History taking (for medical and surgical history)
  2. Physical examination (including heart, blood pressure, electrocardiogram, chest auscultation and difficult airway assessment)
  3. Laboratory investigation (complete blood picture, renal and liver function tests and bleeding profile).

The day before surgery, the study protocol will explained to all patients and the patients will fast for 6 hours before the surgery. All the patients will receive their antihypertensive medications till the morning of surgery

On arrival to the operation room:

Routine monitoring including: electrocardiogram, non-invasive blood pressure and pulse oximetry will be set, Peripheral intravenous cannula will be inserted and acetated Ringer will be started at rate of 4ml/kg/h.

Anesthetic management:

The induction will be similar in both groups; Pre-oxygenation for 5 minutes will be done in all patients and then they will receive 0.02 mg/Kg midazolam, 1μg/Kg fentanyl, 2mg/kg Propofol slowly until loss of verbal contact and rocurronium 0.6 mg/kg intravenously.Till the establishment of adequate neuromuscular block, the patients' ventilation will be assisted manually using a face mask. During this period the patients' lungs will be ventilated with 100% oxygen.

After establishment of adequate neuromuscular block after 3 minutes, the trachea will be intubated using either glidescope or Macintosh laryngoscope.The patient will be intubated by suitable sized tube (in males 8 mm and in females 7.5 mm internal diameter). In Macintosh group we will use a blade size 3, the laryngoscope will be advanced in patient mouth displacing the tongue laterally till the laryngoscope reach the vallecula and then gentle lifting will be applied till visualization of the laryngeal inlet then the tube will be advanced.For endotracheal intubation with glidescope, size 3 blade will be used in all of the cases. Glidescope will be advanced gently in the oral cavity (in the midline) and walked down the tongue. The scope will be further advanced into the vallecula and gentle lifting force will be applied for visualization of the glottis. Endotracheal tube will be loaded on specific rigid stylet with 60 degree bent and will be advanced into the trachea by the same operator.

External pressure to the front of the neck will be applied on request of the operator by another anesthetist.After placement of the endotracheal tube, the cuff of the tube will be inflated gradually with and the chest will be auscultated to ensure proper tracheal positioning and to exclude bronchial intubation and then the tube will be fixed.

All the intubations will be performed by a well-trained anesthetist. The intubation attempt failure will be defined when the intubation time exceed 120 seconds, esophageal intubation occurred or desaturation with arterial oxygen saturation dropped below 90%. Three attempts will only allow,then anesthesia will be carried out according to decision of the attending anesthetist with exclusion of the case from the study. Face-mask intermittent positive pressure ventilation will be carried out in-between the attempts.

The intubation condition will be assessed using first attempt success rate, number of attempts, intubation time and Cormack Lehane score. The intubation time is defined as the period from termination of face mask oxygenation till the appearance of carbon dioxide trace after positive pressure ventilation.

Cormack Lehane score is based on the laryngoscopic view as following: grade 1 full view of the glottis, grade 2 partial view of the glottis, grade 3 only the epiglottis appear and grade 4 neither the glottis nor the epiglottis appear

Monitoring:

Systolic, diastolic, mean arterial blood pressure and heart rate will be recorded at the following time points: T1: before anesthesia, T2: after induction and immediately before intubation, T3: immediate after completion of intubation, T4: after 1 minute of intubation, T5: after 2 minutes of intubation, T6: after 3 minutes of intubation, T7: after 5 minutes of intubation, T8: after 10 minutes of intubation.Maximal blood pressure and heart rate changes will be recorded

Postoperative follow up:

The patient will be assessed 24 hours postoperatively for the sore throat and hoarseness of voice according to the 4-point score

Being tested
Glidescope, Macintosh
Keywords
Glidescope,Macintosh, Laryngscope, intubation,Hypertension.

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • GlidescopeDevice

    The patient will be intubated by suitable sized tube (in males 8 mm and in females 7.5 mm internal diameter).

    For endotracheal intubation with glidescope, size 3 blade will be used in all of the cases. Glidoscope will be advanced gently in the oral cavity (in the midline) and walked down the tongue. The scope will be further advanced into the vallecula and gentle lifting force will be applied for visualization of the glottis. Endotracheal tube will be loaded on specific rigid stylet with 60 degree bent and will be advanced into the trachea by the same operator.

    Systolic, diastolic, mean arterial blood pressure and heart rate will be recorded at the following time points: T1: before anesthesia, T2: after induction and immediately before intubation, T3: immediate after completion of intubation, T4: after 1 minute of intubation, T5: after 2 minutes of intubation, T6: after 3 minutes of intubation, T7: after 5 minutes of intubation, T8: after 10 minutes of intubation.

  • MacintoshDevice

    The patient will be intubated by suitable sized tube (in males 8 mm and in females 7.5 mm internal diameter). In Macintosh group we will use a blade size 3 at first. The laryngoscope will be advanced in patient mouth displacing the tongue laterally till the laryngoscope reach the vallecula and then gentle lifting will be applied till visualization of the laryngeal inlet then the tube will be advanced.Systolic, diastolic, mean arterial blood pressure and heart rate will be recorded at the following time points: T1: before anesthesia, T2: after induction and immediately before intubation, T3: immediate after completion of intubation, T4: after 1 minute of intubation, T5: after 2 minutes of intubation, T6: after 3 minutes of intubation, T7: after 5 minutes of intubation, T8: after 10 minutes of intubation.Maximal arterial blood pressure and heart rate changes will be recorded

Study groups in NCT03316443
Study groupRoleWhat they receive
(Group G)Active comparatorGlidescope group: 45 patients will be intubated by Glidescope (Group G). For endotracheal intubation with glidoscope, size 3 blade will be used in all of the cases. Glidoscope will be advanced gently in the oral cavity (in the midline) and walked down the tongue. The scope will be further advanced into the vallecula and gentle lifting force will be applied for visualization of the glottis. Endotracheal tube will be loaded on specific rigid stylet with 60 degree bent and will be advanced into the trachea by the same operator.
Receives: Device: Glidescope
(Group M)ExperimentalMacintosh group: 45 patients will be intubated by Macintosh laryngoscope (Group M).The patient will be intubated by suitable sized tube (in males 8 mm and in females 7.5 mm internal diameter). In Macintosh group we will use a blade size 3 at first, the laryngoscope will be advanced in patient mouth displacing the tongue laterally till the laryngoscope reach the vallecula and then gentle lifting will be applied till visualization of the laryngeal inlet then the tube will be advanced
Receives: Device: Macintosh

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Arterial blood pressure changes

    Systolic arterial blood pressure changes with the use of each device for endotracheal intubation.

    Measured: During 10 minutes after endotracheal inubation.

  2. Arterial blood pressure changes

    Diastolic arterial blood pressure changes with the use of each device for endotracheal intubation.

    Measured: During 10 minutes after endotracheal intubation.

  3. Arterial blood pressure changes

    Mean arterial blood pressure changes with the use of each device for endotracheal intubation.

    Measured: During 10 minutes of trial of endotracheal intubation.

  4. Heart rate changes

    Heart rate changes with the use of each device for endotracheal intubation.

    Measured: During 10 minutes of trial of endotracheal intubation.

Secondary outcomes (5)
  1. Success rate of endotracheal intubation with each device.

    First attempt success rate for endotracheal intubation completion.

    Measured: During intraoperative trial of endotracheal intubation.

  2. Endotracheal intubation time with each device.

    Total time needed from end of mask ventilation untill endotracheal intubation completion with appearance of CO2 traces.

    Measured: During intraoperative trials of endotracheal intubation.

  3. Attempts of endotracheal intubation with each device.

    Number of attempts needed for completion of endotracheal intubation.

    Measured: During intraoperative trials of endotracheal intubation.

  4. severity of sore throat with each device.

    Sore throat will be graded as none, mild (less severe than with common cold), moderate (similar to common cold) and severe (more severe than with common cold).

    Measured: 24 hours after endotracheal intubation

  5. severity of hoarseness of voice with each device.

    Hoarseness of voice will be graded as none, mild (noted only by the patient), moderate (obvious to the observer) and sever (like aphonia).

    Measured: 24 hours after endotracheal intubation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Oct 2017
  2. Study start1 Nov 2017
  3. Primary completion1 Feb 2019
  4. Study completion1 Dec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Eligible 90 adult patients will be randomly allocated by a computer-generated randomization sequence into 2 equal groups: Macintosh group: 45 patients will be intubated by Macintosh laryngoscope (Group M). Glidescope group: 45 patients will be intubated by Glidescope (Group G).
Masking
Single blind
Who is masked
Participant
Enrolment
90 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03316443
Sponsor's protocol ID
MS/17.10.93
Status last verified
Jan 2021
First submitted
12 Oct 2017
Last updated
12 Jan 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Glidescope and Macintosh in people with Hypertensive Patients, run by Mansoura University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jan 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Arterial blood pressure changes (time frame: During 10 minutes after endotracheal inubation.). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jan 2021; AzTrials last refreshed its copy on 8 Nov 2026.

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