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Obesity Surgery

, Volume 19, Issue 8, pp 1096–1101 | Cite as

Video-Assisted Versus Conventional Tracheal Intubation in Morbidly Obese Patients

  • Gilles DhonneurEmail author
  • Widad Abdi
  • Serge K. Ndoko
  • Roland Amathieu
  • Nabil Risk
  • Lodfi El Housseini
  • Claude Polliand
  • Gerard Champault
  • Xavier Combes
  • Loïc Tual
Research Article

Abstract

Background

We compared tracheal intubation characteristics and arterial oxygenation quality during airway management of morbidly obese patients whose trachea was intubated under video assistance with the LMA CTrach™ (SEBAC, Pantin, France) or the Airtraq™ laryngoscope (VYGON, Écouen, France) with that of the conventional Macintosh laryngoscope.

Methods

After standardized induction of anesthesia, 318 morbidly obese patients scheduled for elective morbid obesity surgery received tracheal intubation with the LMA CTrach™, the Airtraq™ laryngoscope, or the conventional Macintosh laryngoscope. Duration of apnea, time to tracheal intubation, and oxygenation quality during airway management were compared between the LMA CTrach™ and the laryngoscope groups.

Results

Patients’ characteristics were similar in the three groups. The success rate for tracheal intubation was 100% with the LMA CTrach™ and the Airtraq™ laryngoscope. One patient of the Macintosh laryngoscope group received LMA CTrach™ intubation because of early arterial oxygen desaturation associated with unstable facemask ventilation. The duration of apnea was shorter with the LMA CTrach™ than that of the Airtraq™ laryngoscope and the Macintosh laryngoscope. The duration tracheal intubation was shorter with the Airtraq™ laryngoscope than with the Macintosh laryngoscopes and the LMA CTrach™. During airway management, arterial oxygenation was of better quality with the LMA CTrach™ and the Airtraq™ laryngoscope than that of the Macintosh laryngoscope.

Conclusion

Because LMA CTrach™ promoted short apnea time and the Airtraq™ laryngoscope allowed early definitive airway, both video-assisted tracheal intubation devices prevented most serious arterial oxygenation desaturation evidenced during tracheal intubation of morbidly obese patients with the conventional Macintosh laryngoscope.

Keywords

Anesthesia induction Ventilation Tracheal intubation Oxygenation Morbid obesity 

Notes

Acknowledgement

We would like to thank our colleague Patricia Jabre from the Department of Biostatistics EA 3409, Paris 13 School of Medicine, 93000 Bobigny, France, for her assistance.

References

  1. 1.
    Dhonneur G, Ndoko SK, Yavchitz A, et al. Tracheal intubation of morbidly obese patients: LMA CTrach vs direct laryngoscopy. Br J Anaesth. 2006;97:742–5.CrossRefGoogle Scholar
  2. 2.
    Dhonneur G, Ndoko S, Amathieu R, et al. Intubation using the Airtraq® in Morbid Obese Patients Undergoing Emergency Cesarean Delivery. Anesthesiology 2007;106:629–30.CrossRefGoogle Scholar
  3. 3.
    Dhonneur G, Ndoko S-K, Amathieu R, et al. A comparison of two techniques for inserting the Airtraq™ laryngoscope in morbidly obese patients. Anaesthesia 2007;62:774–7.CrossRefGoogle Scholar
  4. 4.
    Ndoko SK, Amathieu R, Tual L, et al. Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. Br J Anaesth. 2008;100:263–8.CrossRefGoogle Scholar
  5. 5.
    Levitan RM, Ochroch EA, Kush S, et al. Assessment of airway visualization: validation of the percentage of glottic opening (POGO) scale. Acad Emerg Med. 1998;5:919–23.CrossRefGoogle Scholar
  6. 6.
    Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997;87:1290–7.CrossRefGoogle Scholar
  7. 7.
    Goldman A, Rosenblatt W. The LMA CTrach™ in airway resuscitation: six case reports. Anaesthesia 2006;61:975–7.CrossRefGoogle Scholar
  8. 8.
    Goldman A, Rosenblatt W. Use of the fiberoptic intubating LMA CTrach™ in two patients with difficult airways. Anaesthesia 2006;61:601–3.CrossRefGoogle Scholar
  9. 9.
    Maharaj CH, Higgins BD, Harte BH, et al. Evaluation of intubation using the Airtraq® or Macintosh laryngoscope by anaesthesiologists in easy and simulated difficult laryngoscopy—a manikin study. Anaesthesia 2006;61:1093–9.CrossRefGoogle Scholar
  10. 10.
    Maharaj CH, Buckley E, Harte BH, et al. Endotracheal intubation in patients with cervical spine immobilization: a comparison of Macintosh and Airtraq laryngoscopes. Anesthesiology 2007;107:53–9.CrossRefGoogle Scholar
  11. 11.
    Maharaj CH, Costello JF, McDonnell JG, et al. The Airtraq as a rescue airway device following failed direct laryngoscopy: a case series. Anaesthesia 2007;62:598–601.CrossRefGoogle Scholar
  12. 12.
    Norman A, Date A. Use of the Airtraq laryngoscope for anticipated difficult laryngoscopy. Anaesthesia 2007;62:533–4.CrossRefGoogle Scholar
  13. 13.
    Combes X, Le Roux B, Suen P, et al. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology 2004;100:1146–50.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Gilles Dhonneur
    • 1
    • 3
    • 4
    Email author
  • Widad Abdi
    • 1
    • 3
  • Serge K. Ndoko
    • 1
    • 3
  • Roland Amathieu
    • 1
    • 3
  • Nabil Risk
    • 2
    • 3
  • Lodfi El Housseini
    • 1
    • 3
  • Claude Polliand
    • 2
    • 3
  • Gerard Champault
    • 2
    • 3
  • Xavier Combes
    • 1
    • 3
  • Loïc Tual
    • 1
    • 3
  1. 1.Anesthesiology and Intensive Care Medicine DepartmentJean Verdier Public University Hospital of Paris (APHP)BondyFrance
  2. 2.Morbid Obesity and Visceral Surgery DepartmentJean Verdier Public University Hospital of Paris (APHP)BondyFrance
  3. 3.Paris 13 School of MedicineBobignyFrance
  4. 4.Département d’Anesthésie et RéanimationCHU (APHP) Jean VerdierBondyFrance

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