Neurophysiological Monitoring and Videolaryngoscopy

  • STATUS
    Recruiting
  • End date
    Dec 21, 2021
  • participants needed
    20
  • sponsor
    Rabin Medical Center
Updated on 26 March 2021
Investigator
Leonid Eidelman
Primary Contact
Rabin Medical Center/Beilinson Campus (6.6 mi away) Contact

Summary

Myopathic patients undergoing cervical spine surgery are at risk for postoperative neurological deficits and sequelae.

Awake fiberoptic intubation is considered the technique of choice for tracheal intubation in patient with cervical spine instability. However, awake fiberoptic intubation frequently causes significant patient discomfort, requires patient cooperation, anesthesiologist expertise and the availability of costly equipment .

Videolaryngoscopy guided intubation is considered to be an effective alternative to awake fiberoptic intubation for cervical spine surgeries.

Intraoperative neurophysiological monitoring (IONM) is a method that provides real time evaluation of the functional integrity of neural structures. The goal of IONM is to make surgery safer by detecting incipient neurological insults at a time when it can be avoided or minimized and by aiding in the identification of neural structure Rayia, et al. have described a case of monitoring intubation and neck extension for the indication of thyroidectomy in a Down syndrome boy with atlantoaxial instability under anesthesia with propofol and remifentanil without neuromuscular blockade. The authors conclude that this approach can be used to protect against spinal cord compression.

While research has thoroughly evaluated the effect of laryngoscopy and intubation on cervical spine movement, to date, little is known about the impact of intubation process on neurophysiological responses, and on the feasibility of utilizing IONM for establishing a safe airway intubation.

This prospective, interventional, cohort study is the first, to our knowledge, to examine the feasibility and added benefits of IONM throughout anesthetic intubation in patients undergoing cervical spine surgeries with the use of videolarynscope guided intubation.

Details
Condition Postsynaptic Potential Summation
Treatment Neurophysiological monitoring during intubation
Clinical Study IdentifierNCT04576637
SponsorRabin Medical Center
Last Modified on26 March 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

All patients above 18y old, presenting for cervical spine surgeries
suffering from cervical spine instability, whom are able to comply with the
study requirements and gave a written informed consent will be eligible for
study enrollment

Exclusion Criteria

Patients presenting with heart disease will not be eligible to participate
Patients with anticipated difficult airway
Patients with a language barrier
Patients with known allergy to any of the drugs used
Pregnant women
Patients with a history of seizures or CVA
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If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

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