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BJA Advance Access originally published online on September 21, 2006
British Journal of Anaesthesia 2006 97(5):742-745; doi:10.1093/bja/ael219
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Tracheal intubation of morbidly obese patients: LMA{dagger} CTrachTM vs direct laryngoscopy

G. Dhonneur1,3,*, S. K. Ndoko1, A. Yavchitz1, A. Foucrier1, C. Fessenmeyer1, C. Pollian2, X. Combes4 and L. Tual1,3

1 Department of Anaesthesia and Intensive Care 93143 Bondy, Cedex, Paris, France
2 Surgery of Obesity Unit-General Surgery Department, Jean Verdier University Hospital of Paris (APHP) 93143 Bondy, Cedex, Paris, France
3 Paris 13 Bobigny School of Medicine 93000 Bobigny Cedex, France
4 Anaesthesia and Intensive Care Department, Henri Mondor University Hospital of Paris (APHP) 94000, Créteil Cedex, France

*Corresponding author: Service d'Anesthésie et Réanimation, CHU Jean Verdier, 93143, Bondy, Cedex, France. E-mail: gilles.dhonneur{at}jvr.aphp.fr

Background. LMA CTrachTM (CT), a modified version of the intubating LMA FastrachTM, allows continuous video-endoscopy of the tracheal intubation procedure. We tested the hypothesis that the CT is efficient for tracheal intubation of morbidly obese patients who are at risk of a difficult airway.

Methods. After Ethics’ Committee approval, 104 morbidly obese patients (BMI >35 kg m–2) scheduled for bariatric surgery were included in this prospective study. Patients were randomly assigned in two groups: tracheal intubation using direct laryngoscopy (DL) or the CT. Induction of anaesthesia was standardized using sufentanil, propofol and succinylcholine. Characteristics and consequences of airway management were evaluated.

Results. Preoperative characteristics of patients and consequences of anaesthesia induction on physiological variables were similar in both groups. Difficulty in facemask ventilation was similar in both groups. Tracheal intubation was successfully carried out with DL and CT. Forty-nine per cent of the patients from the CT group required laryngeal mask manipulation (ventilation and view optimization) resulting in increased duration of tracheal intubation by 57 s as compared with DL. Oxygenation was of better quality in the patients managed with CT than with DL. Blind tracheal intubation was mandatory in eight (17%) patients of the DL group, while tracheal intubation was seen in all patients of the CT group.

Conclusion. We demonstrated that the CT was an efficient airway device for ventilation and tracheal intubation in case of a difficult airway in morbidly obese patients.

{dagger}LMA® is the property of Intavent Ltd.


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E-letters:

Read all E-letters

cTrach: a valuable aid for daily practice in bariatric surgery
Davide Cattano
British Journal of Anaesthesia, 27 Oct 2006 [Full text]
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British Journal of Anaesthesia, 3 Nov 2006 [Full text]
Training in the use of different airway management systems
Awanee Kumar
British Journal of Anaesthesia, 14 Jan 2007 [Full text]
Re: Training in the use of different airway management systems
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