Airway management in a 980-lb patient: use of the Aintree intubation catheter.
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.
Doyle
D John
DJ
Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. doylej@ccf.org
Zura
Andrew
A
Ramachandran
Mangalakaraipudur
M
Lin
Jia
J
Cywinski
Jacek B
JB
Parker
Brian
B
Marks
Theodore
T
Feldman
Marc
M
Lorenz
Robert R
RR
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