Airway management using the intubating laryngeal mask airway for the morbidly obese patient.
We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients scheduled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 +/- 5 kg/m(2)). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then inserted, and the trachea was intubated through the ILMA by a second observer. The rate of successful tracheal intubation with ILMA was 96.3%. The success rate, the number of attempts, and the total duration of the procedure were not different among patients with low-grade (Cormack 1-2) and patients with high-grade (Cormack 3-4) laryngeal views. The time required for insertion of the ILMA was slightly longer in patients with high-grade laryngeal views. Failures of the technique were not explained by the experience of the practitioner or airway characteristics. No adverse effect related to the technique was reported. Results of this study suggest that using the ILMA provides an additional technique for airway management of morbidly obese patients.


CONCLUSIONS
The intubating laryngeal mask airway (ILMA) provides an additional technique for airway management of morbidly obese patients. The best choice of the primary technique (laryngoscopy or ILMA) for tracheal intubation of an adult obese patient remains to be determined.
Frappier
Jérôme
J
Department of Anesthesiology and Intensive Care, European Hospital Georges Pompidou, Paris, France.
Guenoun
Thierry
T
Journois
Didier
D
Philippe
Hervé
H
Aka
Emma
E
Cadi
Philippe
P
Silleran-Chassany
Jacqueline
J
Safran
Denis
D
D000328:Adult; D000768:Anesthesia, General; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D009960:Oropharynx / Q000033:anatomy & histology / Q000502:physiology; D011237:Predictive Value of Tests; D012121:Respiration, Artificial