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Time-to-intubation in obese patients: A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesia and Intensive Care.ORCID iD: 0000-0002-3066-9544
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care.
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2017 (English)In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 83, no 9, 906-913 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Airway management may be difficult in obese patients. Moreover, during prolonged intubation, oxygen desaturation develops rapidly. Videolaryngoscopy improves the view of the larynx, and the Storz® C-MACTM has been shown to be superior to other videolaryngoscopes in terms of intubation time in obese patients. However, no effort has been made to compare the Storz® C-MACTM with direct laryngoscopy. The aim of the study was to evaluate if the use of Storz® C-MACTM may reduce intubation time when compared to direct laryngoscopy (classic Macintosh® blade).

METHODS: eighty patients with body mass index > 35kg/m2 were randomized to orotracheal intubation using either Macintosh® laryngoscope, or the Storz® C-MACTM with the standard Macintosh blade. Patients had no previous history of a difficult airway. Time- to-intubation (TTI) was defined as the time from the moment anaesthetist took the laryngoscope until end-tidal carbon dioxide was detected.

RESULTS: no significant difference in TTI could be demonstrated between the two devices tested (mean difference -1.7s (95% CI -6.9 to 3.5s). All patients in the videolaryngoscopy group were successfully intubated with the allocated device, whereas five patients in the direct laryngoscopy group required an alternative device for successful intubation. No significant difference regarding the subjective difficulty of intubation and postoperative sore throat between groups was demonstrated.

CONCLUSION: in obese patients the airway may be secured equally fast using direct laryngoscopy (Macintosh®) and with videolaryngoscopy using the Stortz® C-MACTM. The risk for failed intubation, however, appears to be greater with direct laryngoscopy, especially in male obese patients.

Place, publisher, year, edition, pages
Edizioni Minerva Medica , 2017. Vol. 83, no 9, 906-913 p.
Keyword [en]
Laryngoscopy; Obesity; Intubation
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-57350DOI: 10.23736/S0375-9393.17.11740-2ISI: 000413240600005PubMedID: 28358178Scopus ID: 2-s2.0-85029081376OAI: oai:DiVA.org:oru-57350DiVA: diva2:1098646
Note

Funding Agency:

Research Fund of the Örebro County Council, Örebro, Sweden 

Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2017-11-10Bibliographically approved
In thesis
1. Perioperative complications in obese patients: A thesis on risk reducing strategies
Open this publication in new window or tab >>Perioperative complications in obese patients: A thesis on risk reducing strategies
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.

The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.

In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.

The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.

The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 74 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 167
Keyword
Intubation time, videolaryngoscopy, obesity, esophagogastric junction, remifentanil, esmolol, high-resolution manometry, pulmonary aspiration, postoperative pain, postoperative opioid-sparing
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-59411 (URN)978-91-7529-215-1 (ISBN)
Public defence
2017-11-24, Örebro universitet Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
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Available from: 2017-08-29 Created: 2017-08-29 Last updated: 2017-11-06Bibliographically approved

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