Clinical experience with the C-Mac videolaryngoscope in morbidly obese patients

Background: The use of videolaryngoscopes is recommended as a part of routine practice in anaesthesia for morbidly obese patients. The aim of this study was to evaluate C-Mac in a group of morbidly obese patients to see if it improves intubation conditions. Methods: 86 morbidly obese (BMI > 40 kg m(-2)) patients scheduled for bariatric surgery were included in the study. In every studied case, C-Mac was used with a Mackintosh shaped blade. For the first attempt, the anaesthetists performing the intubation were asked to use a videolaryngoscope as a standard laryngoscope (they were blinded to the monitor display) and evaluate the glottic view in direct laryngoscopy. Then they were asked to look at the monitor of the videolaryngoscope and intubate the patient. The laryngoscopy conditions were evaluated using the Cormack-Lahane (CL) scale. The time from picking up the laryngoscope to inserting the endotracheal tube was recorded. Results: The evaluation of CL grade in direct laryngoscopy was: 44 patients - grade 1; 23 patients - grade 2; 13 patients - grade 3; six patients - grade 4. In all cases of CL grade > 1 in direct laryngoscopy, the use of C-Mac improved CL grade to 1. Mean time of intubation was 17.2 +/- 2.5 sec. Conclusion: The C-Mac improves laryngeal view in morbidly obese patients, and allows for fast endotracheal intubation.