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    What is COVALENT?

    covalent is a three-arm, randomized-controlled multi center trial. covalent tests the hypothesis that video-assisted laryngoscopy for endotracheal intubation in surgical procedures is non-inferior to conventional direct laryngoscopy.

    This trial is supported by the German Society for Anesthesiology and Intensive Care.

    After informed consent, patients will be randomized into one of three arms. Within each arm, one type of laryngoscope will be used primarily: conventional laryngoscope with a Macintosh-shaped blade, video-assisted laryngoscope with a Macintosh-shaped blade and video-assisted laryngoscope with a hyperangulated blade, respectively. Additionally, interactions between team members (anesthetist and anesthesia nurse)

    inclusion criteria

    • adult patients capable of informed consent
    • elective, non-cardiac surgery under general anesthesia requiring endotracheal intubation

    exclusion criteria

    • pregnancy
    • past enrolment in the trial
    • need for fiberoptic (endoscopic) intubation
    • bariatric surgery
    • urgent medical concerns voiced by the responsible treating anesthetist


    conventional laryngoscopy (control group)
    video-assisted laryngoscopy with Macintosh-shaped blade
    video-assisted laryngoscopy with hyperangulated blade

    endpoints (selection)

    • first-attempt success (dichotomous, primary endpoint)
    • time to successful intubation
    • time to glottis view
    • Cormack & Lehane grade
    • number of attempts
    • drop of peripheral oxygen saturation (SpO2) below 90%
    • dental damage
    • Mayo High Performance Teamwork Scale and NASA taskload index (care providers)
    • coughing or sore throat