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2015, Number 1

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Rev Mex Anest 2015; 38 (1)

Airtraq® versus flexible fiberoptic intubation in morbid obese with difficult airway predictors undergoing bariatric surgery

Vargas-Escalona K, García-Farell C, Ramírez-Paesano C

Language: Spanish
References: 36
Page: 5-14
PDF size: 265.69 Kb.


ABSTRACT

Objective: To compare the characteristics of intubation during anesthesia induction with Airtraq ® versus flexible fiberoptic in morbidly obese patients with anticipated difficult airways undergoing bariatric surgery. Methods: 78 patients with three or more predictors of difficult airway were randomly divided into two groups. In group A were intubated by Airtraq ® device and group F by flexible fiberoptic. All patients were monitored with non invasive blood pressure, pulse oximetry, electrocardiography and muscle relaxation. Anesthesia was performed according to patient weight with propofol, fentanyl and B. rocuronium. Successful intubation was confirmed by capnometry. Results: The successful intubation rate was 100% for both groups. In group F: 20.5% of patients required use of alternative maneuver (mandibular traction) to achieve intubation versus 5.1% in group A (p ‹ 0.05). The time to achieve tracheal intubation with flexible fiberscope was: 78.9 ± 60.6 sec, and the Airtraq ® device: 30.7 ± 20.9 sec (p ‹ 0.001). Conclusions: Our study demonstrates that tracheal intubation with the Airtraq ® device is achieved with less time and less use of alternative maneuvers, when compared with flexible fiberoptic in morbidly obese patients with anticipated difficult airway during anesthesia for bariatric surgery.


REFERENCES

  1. Cartagena R. Preoperative evaluation of patients with obesity and obstructive sleep apnea. Anesthesiol Clin North America. 2005;23:463-478.

  2. Ramírez J, Torrico G, Encinas C. Índices predictores de vía aérea en pacientes obesos. Rev Mex Anest. 2013;36:193-201.

  3. Who’s Certified Brochure [Internet]. Word health statistics. 2012 [citado 05 de febrero de 2012]. Available in: http://www.who.int/gho/publications/world_health_statistics/ES_WHS2012_Brochure.pdf

  4. Euromonitor Certified [Internet]. Consumer Americas. 2012 [citado 01 de marzo de 2012]. Available in: http://www.euromonitor.com/consumer-americas-2012/book

  5. Sinha A. Some anesthetic aspects of morbid obesity. Curr Opin Anaesthesiol. 2009;22:442-446.

  6. Berkow L. What’s new in airway management. In 63th annual refresher course lectures and basic science reviews. Annual meeting of the ASA. 2012;41:31-37.

  7. Encuesta Nacional de Salud y Nutrición (ENSANUT). Salud Pública de México. 2013;55:S151-S160.

  8. Walpole SC, Prieto-Menino D, Edwards P, et al. The weight of nations: an estimation of adult human biomass. BMC Public Health. 2012;12:439.

  9. Cotter K, Nielsen J, Guller M. Influence of obesity on surgical regional anesthesia in the ambulatory setting: An analysis of 9038 blocks. Anesthesiology. 2005;7:102-186.

  10. Toshniwal G, McKelvery GM, Wang H. Stop-bang and prediction of difficult airway in obese patients. J Clin Anesth. 2014;26:360-367.

  11. American Society of Anesthesiologists Task Force. Practice guidelines for management of the difficult airway. An updated report by the American Society of Anesthesiologists Task Force on Management of the difficult airway. Anesthesiology. 2013;118:1-20.

  12. Mace SE. Challenges and advances in intubation: airway evaluation and controversies with intubation. Emerg Med Clin North Am. 2008;26:977-1000.

  13. Escobar J. ¿Cuánto podemos predecir la vía aérea difícil? Rev Chil Anest. 2009;38:84-90.

  14. Ebert T. Perioperative considerations for the morbidly obese. In 60th annual refresher course lectures and basic reviews. Annual meeting of the ASA. 2009;224:1-8.

  15. González H, Minville V, Delanove K, Mazerrolles M, Concina D, Fourcade O. Importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg. 2008;106:1132-1136.

  16. Karcher H. Rhabdomyolisis in an obese patient after total knee arthroplasty. Br J Anesth. 2006;6:822-824.

  17. Brodsky J, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94:732-736.

  18. Solh E, Ali A. Airway management in the obese patient. Clin Chest Med. 2009;30:555-569.

  19. Maharaj C, Costello JF, Harte BH, Laffey JG. Evaluation of the Airtraq® and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia. 2008;63:182-188.

  20. Ndoko SK, Amathieu R, Tual L, Polliand C, Kamoun W, El Housseini L et al. Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. Br J Anesth. 2008;2:263-268.

  21. Lemmens HJ. Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol. 2010;23:485-491.

  22. Hagberg C. Current concepts in the management of the difficult airway. In 60th annual refresher course lectures and basic reviews. Annual meeting of the ASA. 2009;208:1-8.

  23. Fobi-Mathias AL. El presente y futuro de la cirugía bariátrica. Rev Chil Cir. 2010;62:79-82.

  24. Collins J, Lemmens H, Brodsky J, Brock-Utne J. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obesity Surg. 2004;14:1171-1175.

  25. Dhonneur G, Ndoko S, Amathieu R, Housseini LE, Poncelet C, Tual L. Tracheal intubation using the Airtraq in morbid obese patients undergoing emergency cesarean delivery. Anesthesiology. 2007;106:629-630.

  26. Savoldelli GL, Ventura F, Waeber JL, Schiffer E. Use of the Airtraq® as the primary technique to manage anticipated difficult airway: a report of three cases. J Clin Anesth. 2008;20:474-477.

  27. Castañeda M, Batlori M, Gómez M. Laringoscopio óptico Airtraq®. An Sist Sanit Navar. 2009;32:75-83.

  28. Wilson ME, Apiegelhalter D, Robertson JA. Predicting difficult intubation. Br J Anaesth. 1988;61:211-216.

  29. Ketherpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcome of impossible mask ventilation. A review of 50,000 anesthetics. Anesthesiology. 2009;110:891-897.

  30. Santillanes G, Gausche-Hill M. Airway Adjuncts. Emerg Med Clin North Am. 2008;26:1015-1027.

  31. Marrel J, Blanc C, Frascarolo P, Magnusson L. Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesth. 2007;24:1045-1049.

  32. Sakles JC, Rodgers R, Keim SM. Optical and video laryngoscopes for emergency airway management. Intern Emerg Med. 2008;3:139-143.

  33. Nishikawa K, Hukuoka E, Kawagishi T, Shimodate Y. Efficacy of the Airtraq® laryngoscope with a fiberoptic bronchoscope compared with that of Airtraq® alone for tracheal intubation: a manikin study. J Anesth. 2011;25:93-97.

  34. Saracoglu KT, Acarel M, Umuroglu T, Gogus FY. The use of Airtraq laryngoscope versus Machintoch laryngoscope and fiberoptic bronchoscope by experience anesthesiologists. Middle East J Anesthesiol. 2014;22:503-509.

  35. Amathieu R, Combes X, Abdi W, Housseini LE, et al. An algorithm for difficult airway management, modified for modern optical devices (Airtraq® laryngoscope, LMA-CTrach™): a 2 years prospective validation in patients for elective abdominal, gynecologic and thyroid surgery. Anesthesiology. 2011;114:25-33.

  36. Abdellatif AA, Ali MA. GlideScope videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation. Middle East J Anesthesiol. 2014;22:385-392




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