PARAtracheal vs CRIcoid Pressure on GLIttic DEformation (PARAGLIDE)
ConditionAirway Management
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Liege
About this trial
This randomized crossover study evaluates the effects of left paratracheal pressure, cricoid pressure, and no pressure on glottic visualization during videolaryngoscopy in adult surgical patients. The primary endpoint is the Percentage of Glottic Opening (POGO) score assessed by blinded video review. Secondary endpoints include anatomical measures (glottic surface area, vertical and horizontal displacement of the glottic plane) and clinical outcomes (first-pass success, first-pass success without desaturation \<90%, intubation time, Intubation Difficulty Scale, hypoxemia, hemodynamic events, airway trauma, and postoperative sore throat or dysphonia). All outcomes are collected from routine anesthetic practice and video analysis, with no additional procedures.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age ≥ 18 years
Scheduled for elective surgery under general anesthesia requiring endotracheal intubation
ASA physical status I or II
Normal airway anatomy as assessed by the anesthesiologist (Mallampati I-II, no known or anticipated difficult airway)
Disqualifiers
History of difficult intubation or anticipated difficult airway
Known upper airway anatomical abnormalities (e.g., tumors, tracheal deviation, cervical spine instability)
BMI > 35 kg/m²
Gastroesophageal reflux disease or increased aspiration risk
Trial design
Design model
Crossover
Treatments tested in this trial
Cricoid Pressure (30 N)
Procedure/SurgeryManual application of posterior pressure on the cricoid cartilage at a standardized force of 30 newtons. The pressure is applied by a trained operator using one or two fingers, with the goal of compressing the esophagus against the cervical spine. The maneuver is performed after induction of general anesthesia and immediately before videolaryngoscopy. A still image of the glottic view is captured during pressure application.
Left Paratracheal Pressure (30 N)
Procedure/SurgeryManual application of pressure to the left paratracheal region, lateral to the trachea and inferior to the thyroid cartilage, at a standardized force of 30 newtons. The pressure is applied by a trained operator using the thumb or fingers. The maneuver is performed after induction of general anesthesia and immediately before videolaryngoscopy. A still image of the glottic view is captured during pressure application.
Treatment groups
50 Participants
are divided into 3 treatment groupsGroup A: No Pressure (Baseline)No intervention 0 interventions
Group B: Cricoid Pressure (30 N)Active comparator 1 intervention
Group C: Left Paratracheal Pressure (30 N)Experimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Percentage of Glottic Opening (POGO) score
POGO will be scored from video recordings of each condition (no pressure, cricoid, paratracheal) by blinded assessors (0-100%).
Time frame
During laryngoscopy, before tracheal intubationSecondary outcomes
1
Glottic surface area
Glottic surface area will be quantified from videolaryngoscopic images under each condition (no pressure, cricoid, paratracheal) using standardized image analysis by blinded reviewers.
Time frame
During laryngoscopy, before intubation2
Vertical Displacement of the Glottic Plane
The vertical shift of the glottic plane relative to baseline will be measured on recorded videolaryngoscopic images under each condition, assessed by blinded reviewers.
Time frame
During laryngoscopy, before intubation3
Horizontal displacement of the glottic plane
The horizontal (lateral) shift of the glottic plane relative to baseline will be measured on recorded videolaryngoscopic images under each condition, assessed by blinded reviewers.
Time frame
During laryngoscopy, before intubation4
First-pass intubation success
Successful tracheal intubation at the first attempt with the maneuver chosen by the operator.
Time frame
From laryngoscope insertion to first confirmed capnographySponsors and contacts
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Source ClinicalTrials.gov
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