Tracheal intubation of morbidly obese patients:: LMA CTrach™ vs direct laryngoscopy

被引:73
作者
Dhonneur, G.
Ndoko, S. K.
Yavchitz, A.
Foucrier, A.
Fessenmeyer, C.
Polliand, C.
Combes, X.
Tual, L.
机构
[1] Jean Verdier Univ Hosp Paris, APHP, Dept Anaesthesia & Intens Care, F-93143 Bondy, France
[2] Jean Verdier Univ Hosp Paris, APHP, Surg Obes Unit, Dept Gen Surg, F-93143 Bondy, France
[3] Univ Paris 13, Sch Med, F-93000 Bobigny, France
[4] Henri Mondor Univ Hosp Paris, APHP, Anaesthesia & Intens Care Dept, F-94000 Creteil, France
关键词
airway; equipment; laryngeal mask; intubation; obesity;
D O I
10.1093/bja/ael219
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. LMA CTrach (TM) (CT), a modified version of the intubating LMA Fastrach (TM), allows continuous video-endoscopy of the tracheal intubation procedure. We tested the hypothesis that the CT is efficient for tracheal intubation of morbidly obese patients who are at risk of a difficult airway. Methods. After Ethics' Committee approval, 104 morbidly obese patients (BMI > 35 kg m(-2)) scheduled for bariatric surgery were included in this prospective study. Patients were randomly assigned in two groups: tracheal intubation using direct laryngoscopy (DL) or the CT. Induction of anaesthesia was standardized using sufentanil, propofol and succinylcholine. Characteristics and consequences of airway management were evaluated. Results. Preoperative characteristics of patients and consequences of anaesthesia induction on physiological variables were similar in both groups. Difficulty in facemask ventilation was similar in both groups. Tracheal intubation was successfully carried out with DL and CT. Forty-nine per cent of the patients from the CT group required laryngeal mask manipulation (ventilation and view optimization) resulting in increased duration of tracheal intubation by 57 s as compared with DL. Oxygenation was of better quality in the patients managed with CT than with DL. Blind tracheal intubation was mandatory in eight (17%) patients of the DL group, while tracheal intubation was seen in all patients of the CT group. Conclusion. We demonstrated that the CT was an efficient airway device for ventilation and tracheal intubation in case of a difficult airway in morbidly obese patients.
引用
收藏
页码:742 / 745
页数:4
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