title: Intubation of the morbidly obese patient: GlideScope(®)  vs. Fastrach™.
abstract: BACKGROUND
  Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®)  (GS) (Verathon Inc Corporate Headquarters, Bothell, WA, USA) than with the Fastrach™ (FT) (The Laryngeal Mask Company Ltd, Le Rocher, Victoria, Mahe, Seychelles).
  
  
  METHODS
  One hundred patients who were scheduled for bariatric surgery were randomised to tracheal intubation using either a GS or an FT. The inclusion criteria were age 18-60 years and a body mass index of ≥ 35 kg/m(2) . The primary end point was intubation time, and if intubation was not achieved after two attempts, the other method was used for the third attempt.
  
  
  RESULTS
  The mean intubation time was 49 s using the GS and 61 s using the FT (P = 0.86). A total of 92% and 84% of the patients were intubated on the first attempt using the GS and the FT, respectively. One tracheal intubation failed on the second attempt when the GS was used, and five failed on the second attempt when the FT was used. There were no incidents of desaturation and no differences between the groups in terms of mucosal damage or intubation difficulty. We experienced one oesophageal intubation using GS and six oesophageal intubations in five patients using FT. There was no difference between the pain scores or incidence of post-operative hoarseness associated with the two intubation techniques.
  
  
  CONCLUSIONS
  No significant difference between the two methods was found. The GS and the FT may therefore be considered to be equally good when intubating morbidly obese patients.
authors.affiliation: Department of Anaesthesiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. mogens@ydemann.dk
authors.forename: M
authors.initials: M
authors.lastname: Ydemann
authors.forename: L
authors.initials: L
authors.lastname: Rovsing
authors.forename: A L
authors.initials: AL
authors.lastname: Lindekaer
authors.forename: K S
authors.initials: KS
authors.lastname: Olsen
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods; D015992:Body Mass Index; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006685:Hoarseness / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018401:Sample Size; D017211:Treatment Failure; D055815:Young Adult