Video-assisted versus conventional tracheal intubation in morbidly obese patients.
BACKGROUND
We compared tracheal intubation characteristics and arterial oxygenation quality during airway management of morbidly obese patients whose trachea was intubated under video assistance with the LMA CTrach (SEBAC, Pantin, France) or the Airtraq laryngoscope (VYGON, Ecouen, France) with that of the conventional Macintosh laryngoscope.


METHODS
After standardized induction of anesthesia, 318 morbidly obese patients scheduled for elective morbid obesity surgery received tracheal intubation with the LMA CTrach, the Airtraq laryngoscope, or the conventional Macintosh laryngoscope. Duration of apnea, time to tracheal intubation, and oxygenation quality during airway management were compared between the LMA CTrach and the laryngoscope groups.


RESULTS
Patients' characteristics were similar in the three groups. The success rate for tracheal intubation was 100% with the LMA CTrach and the Airtraq laryngoscope. One patient of the Macintosh laryngoscope group received LMA CTrach intubation because of early arterial oxygen desaturation associated with unstable facemask ventilation. The duration of apnea was shorter with the LMA CTrach than that of the Airtraq laryngoscope and the Macintosh laryngoscope. The duration tracheal intubation was shorter with the Airtraq laryngoscope than with the Macintosh laryngoscopes and the LMA CTrach. During airway management, arterial oxygenation was of better quality with the LMA CTrach and the Airtraq laryngoscope than that of the Macintosh laryngoscope.


CONCLUSIONS
Because LMA CTrach promoted short apnea time and the Airtraq laryngoscope allowed early definitive airway, both video-assisted tracheal intubation devices prevented most serious arterial oxygenation desaturation evidenced during tracheal intubation of morbidly obese patients with the conventional Macintosh laryngoscope.
Anesthesiology and Intensive Care Medicine Department, Jean Verdier Public University Hospital of Paris (APHP), 93143, Bondy, France. gilles.dhonneur@jvr.aphp.fr
Gilles
G
Dhonneur
Widad
W
Abdi
Serge K
SK
Ndoko
Roland
R
Amathieu
Nabil
N
Risk
Lodfi
L
El Housseini
Claude
C
Polliand
Gerard
G
Champault
Xavier
X
Combes
Loïc
L
Tual
D000293:Adolescent; D000328:Adult; D001049:Apnea / Q000097:blood / Q000209:etiology; D050110:Bariatric Surgery / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult
D010100:Oxygen