Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial
Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado
Canan Kamile Turna, Zehra Ipek Arslan, Volkan Alparslan, Kamil Okyay, Mine Solak
Abstract
Background
Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients.
Methods
Eighty patients with ASA physical status 1–3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m−2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited.
Results
There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05).
Conclusions
Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.
Keywords
Resumo
Justificativa
A obesidade dificulta a ventilação manual e intubação tracheal, devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos.
Método
Estudamos 80 pacientes com classificação ASA 1–3, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m−2, submetidos à cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq.
Resultados
Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1s vs. 50,7 ± 21,2s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1s vs. 97,4 ± 42,7s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05).
Conclusões
Airtraq parece ser superior à MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.
Palavras-chave
References
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