Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and AirtraqTM laryngoscopes
1 Anaesthesia and Intensive Care Department
2 Visceral and Obesity Surgery Department, Jean Verdier Public University Hospital of Paris (APHP), 93143 Bondy, France
3 Paris 13 School of Medicine, 93000 Bobigny, France
* Corresponding authors: Service d’Anesthésie et Réanimation, CHU Jean Verdier, Avenue du 14 Juillet, 93143 Bondy Cedex, France. E-mail: serge.ndoko{at}jvr.aphp.fr
Background: The AirtraqTM laryngoscope is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. We hypothesized that this new airway device would facilitate tracheal intubation of morbidly obese patients. We compared tracheal intubation performance of standard Macintosh laryngoscope with the AirtraqTM laryngoscope in morbidly obese patients.
Methods: One hundred and six consecutive ASA I–III morbidly obese patients undergoing surgery were randomized to intubation with the Macintosh laryngoscope or the AirtraqTM laryngoscope. Induction of anaesthesia was standardized. If tracheal intubation failed within 120 s with the Macintosh or AirtraqTM, laryngoscopes were switched. Success rate, SpO2, duration of tracheal intubation, and quality of airway management were evaluated and compared between the groups.
Results: Preoperative characteristics of the patients were similar in both groups. In the AirtraqTM group, tracheal intubation was successfully carried out in all patients within 120 s. In the Macintosh laryngoscope group, six patients required intubation with the AirtraqTM laryngoscope. The mean (SD) time taken for tracheal intubation was 24 (16) and 56 (23) s, respectively, with the AirtraqTM and Macintosh laryngoscopes, (P<0.001). SpO2 was better maintained in the AirtraqTM group than in the Macintosh laryngoscope group with one and nine patients, respectively, demonstrating drops of Spo2 to 92% or less (P<0.05).
Conclusions: In this study, the AirtraqTM laryngoscope shortened the duration of tracheal intubation and prevented reductions in arterial oxygen saturation in morbidly obese patients.
Keywords: airway; equipment, laryngoscope; oxygen, therapy
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