Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-18T15:16:09.766Z Has data issue: false hasContentIssue false
  • English
  • Français

Videolaryngoscopy improves intubation condition in morbidly obese patients

Published online by Cambridge University Press:  01 December 2007

J. Marrel ,
C. Blanc ,
P. Frascarolo  and
L. Magnusson
J. Marrel
Affiliation:
University Hospital, Department of Anaesthesiology, Lausanne, Switzerland
C. Blanc
Affiliation:
University Hospital, Department of Anaesthesiology, Lausanne, Switzerland
P. Frascarolo
Affiliation:
University Hospital, Department of Anaesthesiology, Lausanne, Switzerland
L. Magnusson*
Affiliation:
University Hospital, Department of Anaesthesiology, Lausanne, Switzerland
*
Correspondence to: Lennart Magnusson, Department of Anaesthesiology, University Hospital, CHUV BH-10, Lausanne 1011, Switzerland. E-mail: Lennart.Magnusson@chuv.ch; Tel: +41 21 314 20 07; Fax: +41 21 314 20 04
Get access

Summary

Background and objective

Tracheal intubation may be more difficult in morbidly obese patients (body mass index >35 kg m−2) than in the non-obese. Recently, new video-assisted intubation devices have been developed. After some experience with videolaryngoscopy, we hypothesized that it could improve the laryngoscopic view in this specific population and therefore facilitate intubation. The aim of this study was to assess the benefit of a videolaryngoscope on the grade of laryngoscopy in morbid obesity.

Methods

We studied 80 morbidly obese patients undergoing bariatric surgery. They were randomly assigned to one of two groups. One group was intubated with the help of the videolaryngoscope and in the control group the screen of the videolaryngoscope was hidden to the intubating anaesthesiologist. The primary end-point of the study was to assess in both groups the Cormack and Lehane direct and indirect grades of laryngoscopy. The duration of intubation, the number of attempts needed as well as the minimal SPO2 reached during the intubation process were measured.

Results

Grade of laryngoscopy was significantly lower with the videolaryngoscope compared with the direct vision (P < 0.001). When the grade of laryngoscopy was higher than one with the direct laryngoscopy (n = 30), it was lower in 28 cases with the videolaryngoscope and remained the same only in two cases (P < 0.001). The minimal SPO2 reached during the intubation was higher with the videolaryngoscope but it did not reach statistical significance.

Conclusions

In morbidly obese patients, the use of the videolaryngoscope significantly improves the visualization of the larynx and thereby facilitates intubation.

Keywords

OBESITY MORBIDINTUBATION INTRATRACHEALLARYNGOSCOPY, videolaryngoscope
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 12 , December 2007 , pp. 1045 - 1049
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Brodsky, JB, Lemmens, HJ, Brock-Utne, JG, Vierra, M, Saidman, LJ. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94: 732–736.Google Scholar
2.Juvin, P, Lavaut, E, Dupont, H et al. . Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97: 595–600.CrossRefGoogle ScholarPubMed
3.Rose, DK, Cohen, MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41: 372–383.Google Scholar
4.Coussa, M, Proietti, S, Schnyder, P et al. . Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 2004; 98: 1491–1495.Google Scholar
5.Hedenstierna, G, Rothen, HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 2000; 16: 329–335.Google Scholar
6.Adnet, F, Baillard, C, Borron, SW et al. . Randomized study comparing the ‘sniffing position’ with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology 2001; 95: 836–841.Google Scholar
7.Cooper, RM, Pacey, JA, Bishop, MJ, McCluskey, SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005; 52: 191–198.Google Scholar
8.Sun, DA, Warriner, CB, Parsons, DG, Klein, R, Umedaly, HS, Moult, M. The glidescope video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005; 94: 381–384.Google Scholar
9.Iwase, Y, Matsushima, H, Nemoto, M et al. . The efficacy of video intubating laryngoscope for novice residents. Masui 2004; 53: 313–319.Google Scholar
10.Weiss, M, Schwarz, U, Dillier, CM, Gerber, AC. Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy. Paediatr Anaesth 2001; 11: 343–348.Google Scholar
11.Cattano, D, Panicucci, E, Paolicchi, A, Forfori, F, Giunta, F, Hagberg, C. Risk factors assessment of the difficult airway: an Italian survey of 1956 patients. Anesth Analg 2004; 99: 1774–1779.Google Scholar
12.Iohom, G, Ronayne, M, Cunningham, AJ. Prediction of difficult tracheal intubation. Eur J Anaesthesiol 2003; 20: 31–36.CrossRefGoogle ScholarPubMed
13.Reed, MJ, Dunn, MJ, McKeown, DW. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J 2005; 22: 99–102.CrossRefGoogle ScholarPubMed
14.Savva, D. Prediction of difficult tracheal intubation. Br J Anaesth 1994; 73: 149–153.Google Scholar
15.Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.CrossRefGoogle Scholar