Τετάρτη 9 Οκτωβρίου 2019

Efficiency of I-gel Supraglottic Airway Device in Supine and Lateral Decubitus Position in Obese Patient

Efficiency of I-gel Supraglottic Airway Device in Supine and Lateral Decubitus Position in Obese Patient: Condition:   Obesity, Airway

Intervention:   Device: I-gel supraglottic airway device

Sponsor:   Cairo University

Recruiting



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Efficiency of I-gel Supraglottic Airway Device in Supine and Lateral Decubitus Position in Obese Patient

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.



ClinicalTrials.gov Identifier: NCT04119245

Recruitment Status  : Recruiting

First Posted  : October 8, 2019

Last Update Posted  : October 8, 2019

See Contacts and Locations

Sponsor:

Cairo University

Information provided by (Responsible Party):

Bassant M. Abdelhamid, Cairo University



Study DetailsTabular ViewNo Results PostedDisclaimerHow to Read a Study Record

Study Description

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Brief Summary:

Obesity is linked to many complications of respiratory care which are directly related to the obstructive apnea syndrome: difficult airway management including difficult mask ventilation, difficult intubation and obstruction of the upper airway.



I gel which is a non inflatablesupraglottic airway device with a gastric channel is gaining popularity in anesthesia practice because of its ease of insertion and stable positioning.



There are many studies evaluating I-gel for airway managment during different head and necks position ,in prone and lateral position showing both successeful results. Morover, it was evaluated during spontanous and mechanically ventilated patients.



There are limited number of studies evaluating the efficacy of I- gel in mild to moderate obese patients.



The primary aim of this study is to Measure the oropharyngeal airway leak pressure in both supine and lateral position and to determine laryngeal glottic view grade by the fibreoptic bronchoscope.





Condition or disease Intervention/treatment Phase 

Obesity, Airway

Device: I-gel supraglottic airway device

Not Applicable



Detailed Description:

prospective observational cohort study. Induction of anethesisa will be started after pre-oxygenating the patient for 3min , with administerating Propofol (2mg/kg)(lean body weight)), Fentanyl (2μg/kg) and Atracurium (0.5mg/kg)(based on ideal body weight.The patient will to be ventilated by a 100% oxygen and 1.2% isoflurane with fresh gas flow 6L/min for 5 min.immediately after induction heart rate , blood pressure and oxygen saturation will be recorded.



A proper sized I-gel according to the patient's weight and manifacturer instructions (Intersurgical Ltd, UK) ( 4 or 5 adult sizeI-gel) will be lubricated with a water based lubricant from the front and back sides of the device, will be inserted after compelete muscle relaxation (Train of four = zero) In case of insertion problem various adjuvant manoeuvres will be used such as such as head flexion or extension, or slightly pulling or pushing the device. Any additional manoeuvres will be recorded. If insertion or ventilation fails three times in succession, Endotracheal tube will be immediately inserted and the patient will be excluded from the study. The number of excluded cases will be recorded The circut will be connected to the device,Capnograph will be attached and end tidal carbon dioxide will be recorded.



The ventilator parameters will be set with tidal volume (4-6 ml/kg) at a respiratory rate(12-15 breath/min) to maintain ETCO2 from 30-35 mmHg.



Anaethesia will be maintanied by a mixture of 50% oxygen and 50% medical air,Isoflurane 1.2% and Atracurium (0.01 mg/kg) will be given according to train of four . Analgesia of pethidine 100mg IV will be given as intraoperative analgesia.



In order to confirm proper positioning of the I-gel,a fiberoptic bronchoscope will be pass through the device and pushed forward up to1 cm proximal to it to obtain a glottic view.



Afterwards the same patient will be placed in the lateral decubitus position.Blood pressure,Heart rate ,Oxygen saturation and End tidal CO2 will be recorded immedialy. After confirming proper ventilation as before ,confirmation of I-gel position using fiberoptic bronchoscope will be done and recorded.The leak air way pressure test will be done as previously done in supine position and recorded.



The patient will be returned to supine position where a proper size Orogastric tube will be inserted.The surgery can be started and Heamodynamics and ventilation will be monitored.



By the end of the surgery the patient will be reversed from general anaesthesia by administrating Neostigmine (0.04mg/kg) and Atropine (0.01mg/kg). intravenously at (TOF=3) and the I-gel will be removed at the end.The presence of blood on the I-gel device, or the occurrence of any complications, will be recorded.



The patient will be transfered to the post operative care unit





Study Design

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Study Type  : Interventional  (Clinical Trial)

Estimated Enrollment  : 30 participants

Intervention Model: Single Group Assignment

Masking: None (Open Label)

Primary Purpose: Diagnostic

Official Title: Evaluation of the Efficiency of I-gel Supraglottic Airway Device in Mechanical Ventilation in Supine and Lateral Decubitus Position in Obese Patient;Prospective Observational Study

Actual Study Start Date  : August 5, 2019

Estimated Primary Completion Date  : November 5, 2019

Estimated Study Completion Date  : November 30, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Pressure Sores

U.S. FDA Resources



Arms and Interventions

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Arm Intervention/treatment 

Experimental: study group

after induction of general anesthesia, a proper size of Igel will be inserted after compelete muscle relaxation. In order to confirm proper positioning of the I-gel,a fiberoptic bronchoscope will be pass through the device and pushed forward up to1 cm proximal to it to obtain a glottic view, leak airway pressure test will be done.



Afterwards the same patient will be placed in the lateral decubitus position ,confirmation of I-gel position using fiberoptic bronchoscope will be done and recorded.The leak air way pressure test will be done as previously done in supine position and recorded.



The patient will be returned to supine position.



Device: I-gel supraglottic airway device

After induction of general anesthesia, we will measure the Oropharyngeal leak airway pressure during controlled ventilation in supine and in positions after insertion of I-gel.







Outcome Measures

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Primary Outcome Measures  :

supine Oropharyngeal leak airway pressure [ Time Frame: 1 minute ]

Oropharyngeal leak airway pressure during controlled ventilation in supine position after insertion of I-gel by one minute.





Secondary Outcome Measures  :

lateral Oropharyngeal leak airway pressure [ Time Frame: 1 minute ]

Measure the Oropharyngeal leak airway pressure during controlled ventilation in lateral position after one minute from setting patient in lateral postion.



Time of insertion [ Time Frame: 3 minutes ]

Time of insertion which is defined as from picking up of the I-gel airway device until the presence of a square wave pattern on the capnograph and Number of insertion attempts.



• Fibro-optic view.The position of the mask is determined by pushing the fibro-optic to a maximum of 1cm over the I gel.





Swallowing [ Time Frame: 5 hours ]

The presence of swallowing difficulties, are questioned preoperatively and 5H postoperatively.



Hoarseness [ Time Frame: 5 hours ]

The presence of Hoarseness is questioned preoperatively and 5H postoperatively.



Nausea and vomiting [ Time Frame: 5 hours ]

The presence of nausea and vomiting are questioned preoperatively and 5H postoperatively.





Eligibility Criteria

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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.





Ages Eligible for Study:  18 Years to 60 Years   (Adult)

Sexes Eligible for Study:  All

Accepts Healthy Volunteers:  No

Criteria

Inclusion Criteria:



BMI: ≥30 - <40. Surgery: short time procedures >60 minutes and ≤. 120 minutes



Exclusion Criteria:



Patientswith neck or upper airway pathologies or other contraindications to supraglottic decives.



Patients at risk of stomach contents regurge e.g. pregnant ,GIT Ulcer, Symptomatic reflux disease or Hiatus hernia ...etc Patients with risk of pulmonary aspiration e.g. Full stomach or incompetent gastro-oesophageal sphincter.



History of gastric band or gastric bypass surgeries. Pregnant females. Laparotomy or laparoscopic procedures. Obstructive sleep apnea Patients with risk of bleeding.



Contacts and Locations

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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.



Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04119245





Contacts

Contact: Bassant M. abdelhamid, M.D. 01224254012 bassantmohamed197@yahoo.com

Contact: Inas Farouk, M.D. +201001587333 inasfarouk@hotmail.com



Locations

Egypt

Cairo university Recruiting

Cairo, Egypt, 11562

Contact: Bassant M. Abdelhamid, M. D.    01224254012 ext 002    Bassantmohamed197@yahoo.com   

Contact: Inas Farouk, M. D.       inasfarouk@hotmail.com   

Sponsors and Collaborators

Cairo University

Investigators

Principal Investigator: Bassant abdelhamid, M.D. Cairo University

More Information

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Publications:

Bamgbade OA, Macnab WR, Khalaf WM. Evaluation of the i-gel airway in 300 patients. Eur J Anaesthesiol. 2008 Oct;25(10):865-6. doi: 10.1017/S0265021508004511. Epub 2008 Jun 6.

Sanuki T, Uda R, Sugioka S, Daigo E, Son H, Akatsuka M, Kotani J. The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients. Eur J Anaesthesiol. 2011 Aug;28(8):597-9. doi: 10.1097/EJA.0b013e32834698f4.

Saracoglu KT, Demir A, Pehlivan G, Saracoglu A, Eti Z. Analysing the efficacy of the I-gel supraglottic airway device in the supine and lateral decubitus positions. Anaesthesiol Intensive Ther. 2018;50(4):259-262. doi: 10.5603/AIT.a2018.0028. Epub 2018 Sep 17.



Responsible Party: Bassant M. Abdelhamid, associate professor, Cairo University

ClinicalTrials.gov Identifier: NCT04119245     History of Changes

Other Study ID Numbers: S-12-2019

First Posted: October 8, 2019    Key Record Dates

Last Update Posted: October 8, 2019

Last Verified: October 2019

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No

Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Bassant M. Abdelhamid, Cairo University:

obesity

Igel

suraglotic device

Additional relevant MeSH terms:

Obesity

Overnutrition

Nutrition Disorders

Overweight

Body Weight

Signs and Symptoms





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