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Intraocular Pressure[Intubation]NCT05763056

Effects of Intubation on Intra-ocular Pressure and Optic Nerve Sheath Diameter

A study testing McGrath videolaryngoscopy, C-MAC videolaryngoscopy and Direct laryngoscopy in people with Intraocular Pressure, run by Inonu University at 1 site in Turkey (Türkiye).

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

Brief Summary: In this study, the investigators aimed to compare the effects of different types of endotracheal instruments (Machintosh laryngoscope, McGrath videoingoscope and C-Mac videoryngoscope) on intraocular pressure, optic nerve diameter and hemodynamic parameters. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Intraocular Pressure
What is being tested?
McGrath videolaryngoscopy, C-MAC videolaryngoscopy and Direct laryngoscopy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Sep 2023to 8 Nov 2023
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 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Non-ophthalmic surgery
  • Mallampati I or II classifications
  • American Society of Anesthesiologists (ASA) I-II

Who cannot join

  • Glaucoma,
  • Diabetes mellitus,
  • Cardiovascular diseases,
  • Pulmonary diseases,
  • ASA 3 and 4
  • Body Mass Index (BMI) greater than 30
Show all 13Show fewer
  • Eye surgery
  • Difficult intubation (Mallampati score of 3 or 4, thyromental distance of less than 6 cm and a maximum mouth opening of less than 3 cm)
  • Intraocular pressure value more than 20 mmHg
  • More than two intubation attempts
  • A risk of regurgitation patients
  • History of obstetric surgery
  • Allergies to propofol, fentanyl or rocuronium

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Inonu University Medical Faculty

    Malatya, 44090

Other trials in Turkey (Türkiye)

About this study

Official title: Comparison of the Effects of Intubation With a Machintosh Laryngoscope, McGrath Videolaryngoscope and C-Mac Videolaryngoscope on Intra-ocular Pressure, Optic Nerve Sheath Diameter and Haemodynamic Parameters

Brief Summary:

In this study, the investigators aimed to compare the effects of different types of endotracheal instruments (Machintosh laryngoscope, McGrath videoingoscope and C-Mac videoryngoscope) on intraocular pressure, optic nerve diameter and hemodynamic parameters.

Read the detailed description

Detailed Description:

Laryngoscopy and endotracheal intubation cause increased intracranial pressure due to hypoxia, hypercapnia, straining, or coughing. It may be an indirect result of increased arterial and venous pressure, as well as a direct effect of intubation.

With the emergence of neuroimaging techniques and new diagnostic tools, various methods have been developed that can replace invasive methods, which are the gold standard in intraocular pressure measurement. However, invasive methods such as intraventricular and intraparenchymal catheter systems have some disadvantages and are associated with significant risks in terms of infection, bleeding, and time lost until follow-up.

The intraorbital subarachnoid space surrounding the optic nerve shows the same pressure variation as the intracranial subarachnoid space, and any increase in intracranial pressure is also seen in the orbital subarachnoid space. With the increase in intracranial pressure, the optic nerve, optic nerve sheath diameter, and subarachnoid space enlarge. There are many studies reporting that optic nerve sheath diameter can be evaluated using ultrasonography. Although there is no clear cut-off value for optic nerve sheath diameter, previous studies have found that an optic nerve sheath diameter of 5.0 mm and above may indicate an increase in intracranial pressure.

Previous studies have determined that the distribution of intraocular pressure in the adult population varies between 11 mmHg and 21 mmHg, and the mean intraocular pressure is 16.5 mmHg. It is well known that the sympathoadrenergic response caused by laryngoscopy and tracheal intubation significantly increases intraocular pressure (at least 10-20 mmHg). In addition, intravenous pressure and intraocular pressure increase due to cough, airway obstruction, succinylcholine use, hypoxia and hypercapnia during intubation.

In this study, the investigators aimed to compare the effects of different types of endotracheal instruments (Machintosh laryngoscope, McGrath videoingoscope and C-Mac videoringoscope) on intraocular pressure, optic nerve sheath diameter and hemodynamic parameters.

Being tested
McGrath videolaryngoscopy, C-MAC videolaryngoscopy, Direct laryngoscopy
Keywords
laryngoscope, intraocular pressure, optic nerve sheath

What participants receive

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

  • McGrath videolaryngoscopyProcedure or surgery

    The McGrath video laryngoscope has a thin, disposable, clear, regularly shaped blade similar to a Macintosh blade and a large LCD display attached to the arm. It is lighter in weight and the Mc VL has a small camera at the tip, with a more compact screen and handle that can make tracheal intubation easier and faster in normal or difficult airway. The smaller volume, thinner and portrait screen helps reduce blind spots

  • C-MAC videolaryngoscopyProcedure or surgery

    The Macintosh blade is attached to the handle and the light beam is passed through the blade tip into a small metal guide tube indented 40 mm. The camera cable is connected to the control unit and the optical cable is connected to the light source. The video macintosh system is installed in a small trolley for easy portability of the device. The trolley supports an 8-inch monitor mounted on a rotating arm on the patient's left side. C-MAC VL devices can create continuous video recordings or static images on a secure removable digital card. The electronic module includes 2 buttons for photo and video shooting. In addition, the image of the C-MAC VL device can be viewed on other devices or recorded via a standard video output port. 3 C-MAC VL reusable metal macintosh blades (sizes 2 to 4) can be used for adult patients. These non-disposable knives have a closed design without gaps in terms of hygiene and have beveled edges to prevent tissue damage.

  • Direct laryngoscopyDevice

    During intubation with a direct laryngoscope (DL), the laryngoscope is inserted into the oral cavity from the right side of the mouth, the tongue is pushed to the left, and after advancing up to the vallecula, it hangs up and forward. In this way, the floor of the mouth and the epiglottis structure are removed from the field of view. If a straight blade laryngoscope is to be used, it is advanced so that the epiglottis remains under the blade after viewing the epiglottis (1). In DL, manipulations such as head extension, sniffing position, and compression of the cricoid cartilage may be required to facilitate visualization of the vocal folds. In 10-15% of the complications experienced during intubation with DL, there are problems related to the angle of view.

Study groups in NCT05763056
Study groupRoleWhat they receive
McGrath videolaryngoscopyActive comparatorIt is a portable videoryngoscope weighing only 325 grams. The CameraStickTM component consists of a light source and a miniature camera, and the image is displayed on a 1.7 inch LCD (Liquid Crystal Display) screen mounted on top of the laryngoscope handle. At the same time, the LCD screen maintains visual contact with the patient and the laryngoscope, can be rotated up to 90°, allowing the user to work in a comfortable posture while performing tracheal intubation. The blade length is suitable for children over 5 years old and adults, thus reducing the trouble of storing different sized blades in the emergency intubation trolley. The blades are sterile and there is no risk of contamination as they are disposable.
Receives: Procedure: McGrath videolaryngoscopy; Procedure: C-MAC videolaryngoscopy; Device: Direct laryngoscopy
C-MAC videolaryngoscopyActive comparatorConsidering the importance of first attempt success in intubation, their use in emergency airway management has increased due to the high first attempt success rate in C-MAC VLs. In patients with cervical spine injury, semi-rigid collars used to prevent neck extension and neck movements cause poor laryngeal vision with Direct laryngoscope and difficulty intubation. C-MAC Video laryngoscope provides a better laryngeal view in these patients
Receives: Procedure: McGrath videolaryngoscopy; Procedure: C-MAC videolaryngoscopy; Device: Direct laryngoscopy
Direct laryngoscopyActive comparatorMacintosh laryngoscopy is still one of the most commonly used advanced airway methods today. For an ideal glottis view in direct laryngoscopy, the mouth and larynx should be in alignment. For this, longitudinal flexion and head extension maneuvers are performed. Reasons such as the clinical situation during intubation and the anatomical variation in the patient may prevent this maneuver from being performed.
Receives: Procedure: McGrath videolaryngoscopy; Procedure: C-MAC videolaryngoscopy; Device: Direct laryngoscopy

What is being measured

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

  1. Intraocular pressure-1

    Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.

    Measured: Intraocular pressure will be measured at before induction

  2. Intraocular pressure-2

    Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.

    Measured: Intraocular pressure will be measured at just before laryngoscopy and intubation

  3. Intraocular pressure-3

    Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.

    Measured: Intraocular pressure will be measured at immediately after intubation

  4. Intraocular pressure-4

    Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.

    Measured: Intraocular pressure will be measured at 5 minutes after intubation

  5. Intraocular pressure-5

    Right and left intraocular pressures will be measured with a Tono-pen (AVIA) (Reichert Technologies, Depew, NY, USA) device by an ophthalmologist unaware of the patient group. Initial intraocular pressure value will measured without using any sedative drugs. An ophthalmologist, unaware of the randomization, measured intraocular pressure using ocular sonography. It will be measured as intraocular pressure: mmHg.

    Measured: Intraocular pressure will be measured at 10 minutes after intubation

Secondary outcomes (5)
  1. Optic nerve diameter measurement-1

    Optic nerve diameter measurements will be made from the transverse and sagittal planes of both eyes using a linear 6-12 MHz transducer (EsaoteMyLabFive, Genoa, Italy). An ophthalmologist, unaware of the randomization, measured optic nerve diameter using ocular sonography. It will be measured as optic nerve sheath diameter: mm.

    Measured: Optic nerve diameter measurement-1 will be measured at before induction

  2. Optic nerve diameter measurement-2

    Optic nerve diameter measurements will be made from the transverse and sagittal planes of both eyes using a linear 6-12 MHz transducer (EsaoteMyLabFive, Genoa, Italy). An ophthalmologist, unaware of the randomization, measured optic nerve diameter using ocular sonography. It will be measured as optic nerve sheath diameter: mm.

    Measured: Optic nerve diameter measurement-2 will be measured at just before laryngoscopy and intubation

  3. Optic nerve diameter measurement-3

    Optic nerve diameter measurements will be made from the transverse and sagittal planes of both eyes using a linear 6-12 MHz transducer (EsaoteMyLabFive, Genoa, Italy). An ophthalmologist, unaware of the randomization, measured optic nerve diameter using ocular sonography. It will be measured as optic nerve sheath diameter: mm.

    Measured: Optic nerve diameter measurement-3 will be measured at immediately after intubation

  4. Optic nerve diameter measurement-4

    Optic nerve diameter measurements will be made from the transverse and sagittal planes of both eyes using a linear 6-12 MHz transducer (EsaoteMyLabFive, Genoa, Italy). An ophthalmologist, unaware of the randomization, measured optic nerve diameter using ocular sonography. It will be measured as optic nerve sheath diameter: mm.

    Measured: Optic nerve diameter measurement-4 will be measured at 5 minutes after intubation

  5. Optic nerve diameter measurement-5

    Optic nerve diameter measurements will be made from the transverse and sagittal planes of both eyes using a linear 6-12 MHz transducer (EsaoteMyLabFive, Genoa, Italy). An ophthalmologist, unaware of the randomization, measured optic nerve diameter using ocular sonography. It will be measured as optic nerve sheath diameter: mm.

    Measured: Optic nerve diameter measurement-5 will be measured at 10 minutes after intubation

Timeline

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

  1. First posted10 Mar 2023
  2. Study start1 Sep 2023
  3. Primary completion8 Nov 2023
  4. Study completion8 Nov 2023

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel Assignment Prospective Randomized, Placebo-Controlled Clinical Trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
120 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05763056
Sponsor's protocol ID
ekaraaslan4
Acronym
[Intubation]
Status last verified
Nov 2023
First submitted
17 Jan 2023
Last updated
9 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011 Jul;37(7):1059-68. doi: 10.1007/s00134-011-2224-2. Epub 2011 Apr 20.

    PubMed 21505900

Questions about this trial

What is this clinical trial studying?

A study testing McGrath videolaryngoscopy, C-MAC videolaryngoscopy and Direct laryngoscopy in people with Intraocular Pressure, run by Inonu University at 1 site in Turkey (Türkiye).

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 3 inclusion and 13 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 9 Nov 2023. 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 Turkey (Türkiye). 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?

Intraocular pressure-1 (time frame: Intraocular pressure will be measured at before induction). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05763056, which also lists 1 linked publication.

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 9 Nov 2023.

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