Trial reportBMC anesthesiology2019
The influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation study.
Trial report in BMC anesthesiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 18 citations in OpenAlex.
- SAFE anaesthesia for patients at risk of pulmonary aspiration: A nationwide survey.European journal of anaesthesiology and intensive care · 2025Article
- A Comparison of Tracheal Intubation Using Direct Laryngoscope and Video Laryngoscope in the Sellick and Trendelenburg Position with That Using Direct Laryngoscope in the Supine Sniffing Position: A Randomized Controlled Trial.Journal of clinical medicine · 2024Article
- Article
- Assessment of the Possibility of Using the Laryngoscopes Macintosh, McCoy, Miller, Intubrite, VieScope and I-View for Intubation in Simulated Out-of-Hospital Conditions by People without Clinical Experience: A Randomized Crossover Manikin Study.Healthcare (Basel, Switzerland) · 2023Article
- An Evaluation of the Intubrite Laryngoscope in Simulated In-Hospital and Out-of-Hospital Settings by Individuals with No Clinical Experience: A Randomized, Cross-Over, Manikin Study.Diagnostics (Basel, Switzerland) · 2022Article
- Effect of patient head position on the aspirated volume of regurgitated clear fluid. A fresh human cadaver study.Anaesthesiology intensive therapy · 2020Article
- A way forward in pulmonary aspiration incidence reduction: ultrasound, mathematics, and worldwide data collection.Brazilian journal of anesthesiology (Elsevier)Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants' airway management.
methodsEighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study. Anaesthesia was induced in reverse Trendelenburg position (+ 15°) in a manikin capable of dynamic fluid regurgitation. Participants were randomised to change to Trendelenburg position (- 15°) a) as soon as regurgitation was noticed, b) as soon as 'patient' had been anaesthetised, and c) as soon as 'patient' had been anaesthetised and with full cervical spine extension (Sellick). Primary endpoints were the aspirated volume and the time to intubation. Secondary endpoints were ratings of the laryngoscopic view and the intubation situation (0-100 mm).
resultsCombining head-down tilt with Sellick position significantly reduced aspiration (p < 0.005). Median time to intubate was longer in Sellick position (15 s [8-30]) as compared with the head in sniffing position (10 s [8-12.5]; p < 0.05). Participants found laryngoscopy more difficult in Sellick position (39.3 ± 27.9 mm) as compared with the sniffing position (23.1 ± 22.1 mm; p < 0.05). Both head-down tilt intubation situations were considered equally difficult: 34.8 ± 24.6 mm (Sniffing) vs. 44.2 ± 23.1 mm (Sellick; p = n.s).
conclusionsIn a simulated setting, using a manikin-based simulator capable of fluid regurgitation, a - 15° head-down tilt with Sellick position reduced the amount of aspirated fluid but increased the difficulty in visualising the vocal cords and prolonged the time taken to intubate. Assessing the airway management in the identical position in healthy patients without risk of aspiration might be a promising next step to take.
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