title: The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient.
abstract: This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, 5.5 cm) a difficult airway was anticipated. Classic direct laryngoscopy using a Macintosh blade size IV failed, despite three intubation attempts-each resulting in a Cormack-Lehane grade IV view. Intubation using a video-assisted Macintosh laryngoscope (V-Mac; Karl Storz, Tuttlingen, Germany) was successful upon the first attempt. The maximum force exerted on the patient's maxillary incisors was 61 N by direct laryngoscopy and 7.6 N using the indirect videolaryngoscope, both using a Macintosh blade.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven 5623 EJ, The Netherlands.
authors.forename: Ralph
authors.initials: R
authors.lastname: Maassen
authors.forename: Ruben
authors.initials: R
authors.lastname: Lee
authors.forename: André
authors.initials: A
authors.lastname: van Zundert
authors.forename: Richard
authors.initials: R
authors.lastname: Cooper
mesh_terms: D000768:Anesthesia, General; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D020704:Laryngoscopes / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010100:Oxygen / Q000097:blood; D011187:Posture
chemical_list: D010100:Oxygen
references.citation: Can J Anaesth. 2005 Jan;52(1):100-4
references.pmid: 15625265
references.citation: Acta Anaesthesiol Belg. 2007;58(2):129-31
references.pmid: 17710902
references.citation: J Anesth. 2008;22(2):191-2
references.pmid: 18500622
references.citation: Can J Anaesth. 2007 Apr;54(4):307-13
references.pmid: 17400984
references.citation: J Clin Anesth. 2007 Aug;19(5):339-45
references.pmid: 17869983
references.citation: Can Anaesth Soc J. 1985 Jul;32(4):429-34
references.pmid: 4027773
references.citation: Can J Anaesth. 1996 Jul;43(7):665-71
references.pmid: 8807170
references.citation: Surg Endosc. 2006 Apr;20 Suppl 2:S479-83
references.pmid: 16544062
references.citation: J Anesth. 2008;22(1):81-5
references.pmid: 18306022
references.citation: Anesth Analg. 2009 Jan;108(1):187-91
references.pmid: 19095848
references.citation: Anesth Analg. 1996 Nov;83(5):1130-1
references.pmid: 8895304
references.citation: Anesth Analg. 1997 Feb;84(2):419-21
references.pmid: 9024040
references.citation: Anaesthesia. 1984 Nov;39(11):1105-11
references.pmid: 6507827
references.citation: Anesth Analg. 2006 Jun;102(6):1867-78
references.pmid: 16717341
references.citation: J Anesth. 2009;23(1):162-3
references.pmid: 19234847
references.citation: J Clin Anesth. 2004 May;16(3):173-6
references.pmid: 15217655
references.citation: Can J Anaesth. 1993 Mar;40(3):279-82
references.pmid: 8467551
references.citation: Anesthesiology. 1999 May;90(5):1302-5
references.pmid: 10319777
references.citation: Can J Anaesth. 2003 Jun-Jul;50(6):611-3
references.pmid: 12826557
references.citation: Anesth Analg. 2004 Jan;98(1):264-265
references.pmid: 14693634
references.citation: J Clin Anesth. 2006 Aug;18(5):357-62
references.pmid: 16905081
references.citation: Anesth Analg. 2003 Jun;96(6):1841-1842
references.pmid: 12761028
references.citation: Can J Anaesth. 2005 Feb;52(2):191-8
references.pmid: 15684262