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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2017 Mar 28
Copyright © 2017 EDIZIONI MINERVA MEDICA
Time-to-intubation in obese patients. A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists
Fredrik ANDER 1 ✉, Anders MAGNUSON 2, Lars BERGGREN 1, Rebecca AHLSTRAND 1, Alex de LEON 1
1 Department of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden; 2 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
BACKGROUND: Airway management may be difficult in obese patients. Moreover, during prolonged intubation, oxygen desaturation develops rapidly. Videolaryngoscopy improves the view of the larynx, and the Storz® C-MACTM has been shown to be superior to other videolaryngoscopes in terms of intubation time in obese patients. However, no effort has been made to compare the Storz® C-MACTM with direct laryngoscopy. The aim of the study was to evaluate if the use of Storz® C-MACTM may reduce intubation time when compared to direct laryngoscopy (classic Macintosh® blade).
METHODS: eighty patients with body mass index > 35kg/m2 were randomized to orotracheal intubation using either Macintosh® laryngoscope, or the Storz® C-MACTM with the standard Macintosh blade. Patients had no previous history of a difficult airway. Time- to-intubation (TTI) was defined as the time from the moment anaesthetist took the laryngoscope until end-tidal carbon dioxide was detected.
RESULTS: no significant difference in TTI could be demonstrated between the two devices tested (mean difference -1.7s (95% CI -6.9 to 3.5s). All patients in the videolaryngoscopy group were successfully intubated with the allocated device, whereas five patients in the direct laryngoscopy group required an alternative device for successful intubation. No significant difference regarding the subjective difficulty of intubation and postoperative sore throat between groups was demonstrated.
CONCLUSION: in obese patients the airway may be secured equally fast using direct laryngoscopy (Macintosh®) and with videolaryngoscopy using the Stortz® C-MACTM. The risk for failed intubation, however, appears to be greater with direct laryngoscopy, especially in male obese patients.
KEY WORDS: Direct laryngoscopy - Videolaryngoscopy - Obese - Time to intubation