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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 September;82(9):966-73
Near-zero difficult tracheal intubation and tracheal intubation failure rate with the “Besta Airway Algorithm” and “Glidescope® in morbidly obese” (GLOBE)
Elena CAGNAZZI 1, Alessandro MOSCA 1, Federico PE 1, Tiziana TOGAZZARI 1, Ottavia MANENTI 1, Francesco MITTEMPERGHER 2, Elena RAFFETTI 3, Francesco DONATO 3, Nicola LATRONICO 1, 4 ✉
1 Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, Italy; 2 Department of General Surgery, Spedali Civili University Hospital, Brescia, Italy; 3 Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy; 4 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health Unit of Surgical Specialties, University of Brescia, Italy
BACKGROUND: Unpredicted Difficult Tracheal Intubation (DTI) with Macintosh occurs frequently in obese patients. We investigated the incidence of DTI using an algorithm based on preoperative assessment with the El-Ganzouri Risk Index (EGRI) and Glidescope® routine use.
METHODS: We prospectively enrolled morbidly obese patients undergoing abdominal surgery. Patients were scheduled for Glidescope® intubation under general anesthesia if EGRI was <7 or awake Flexible Fiber-optic Intubation if EGRI was ≥7. The primary outcome was the DTI rate, defined as Cormack and Lehane grades ≥III, Intubation Difficulty Scale >5 and modified Intubation Difficulty Scale >5. Secondary outcomes included intubation success on the first attempt, the Time to Cormack, the time to intubation, failure to intubate, oxygen desaturation and difficult ventilation.
RESULTS: Of the 214 patients enrolled, 212 (99%) were intubated with Glidescope® and 2 (1%) with awake Flexible Fiber-optic Intubation (one electively, one after a Glidescope® failure). There were no cases of DTI assessed using Cormack and Lehane and Intubation Difficulty Scale, and 3 cases (1.4%; 95% CI 0.45-4.29%) assessed using modified Intubation Difficulty Scale. Of the 213 patients intubated with Glidescope®, 185 (87%) had successful intubation on the first attempt. Mean Time to Cormack and time to intubation were 13.1 (SD 9.6) and 38.1 seconds (SD 21.1) respectively. We had one case (0.5%) of failed Glidescope® intubation and no cases of clinically significant complications.
CONCLUSIONS: The incidence of DTI and Intubation Failure was reduced to near-zero using Glidescope® and the Besta Airway Algorithm in this sample of morbidly obese patients.