title: Airway management in a 980-lb patient: use of the Aintree intubation catheter.
abstract: We report a 22-year-old, 980-lb (445 kg) man with a body mass index of 163 kg/m(2), who needed intubation for tracheotomy surgery, as he was profoundly hypercarbic and reliant on a tight-fitting continuous positive airway pressure mask. Attempts at oral and nasal fiberoptic intubation during topical anesthesia were unsuccessful because of poor patient cooperation and epistaxis. Thus, after awake placement of a size 5 Laryngeal Mask Airway ProSeal LMA; (LMA North America, San Diego, CA), we induced anesthesia using sevoflurane. Then we placed an Aintree stylet (Cook Critical Care, Bloomington, IN) over a fiberoptic bronchoscope, and both were introduced through the LMA into the trachea. We then removed the fiberoptic bronchoscope followed by the LMA. A Parker size 7.5 endotracheal tube was then "railroaded" over the Aintree catheter into the trachea.
authors.affiliation: Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. doylej@ccf.org
authors.forename: D John
authors.initials: DJ
authors.lastname: Doyle
authors.forename: Andrew
authors.initials: A
authors.lastname: Zura
authors.forename: Mangalakaraipudur
authors.initials: M
authors.lastname: Ramachandran
authors.forename: Jia
authors.initials: J
authors.lastname: Lin
authors.forename: Jacek B
authors.initials: JB
authors.lastname: Cywinski
authors.forename: Brian
authors.initials: B
authors.lastname: Parker
authors.forename: Theodore
authors.initials: T
authors.lastname: Marks
authors.forename: Marc
authors.initials: M
authors.lastname: Feldman
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lorenz
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004844:Epistaxis / Q000209:etiology; D004867:Equipment Design; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000150:complications*; D011175:Positive-Pressure Respiration / Q000295:instrumentation