Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2012.07.004
Brazilian Journal of Anesthesiology
Scientific Article

Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq(tm) video laryngoscope in obese patients

Dados da avaliação pré-anestésica não influenciam o tempo de intubação com o videolaringoscópio Airtraq(r) em pacientes obesos

Dante Ranieri Jr.; Fabio Riefel Zinelli; Adecir Geraldo Neubauer; Andre P. Schneider; Paulo do Nascimento Jr.

http://dx.doi.org/10.1016/j.bjane.2012.07.004 Braz J Anesthesiol, vol.64, n3, p.190-194, 2014
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Abstract

Purpose: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq(tm) laryngoscopes. Methods: from 132 bariatric surgery patients (body mass index = 35 kg m-1), cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64) or an Airtraq(tm) (n = 68) laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq(tm) laryngoscope groups (p < 0.01), respectively. Cormack-Lehane scores were also lower for the Airtraq(tm) group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq(tm). Cervical circumference (p < 0.01) and interincisor distance (p < 0.05) influenced the time required for intubation in the Macintosh group but not in the Airtraq(tm) group. Conclusion: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq(tm) laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.

Resumo

Objetivo: esse estudo investigou a influência de preditores anatômicos para laringoscopia e intubação orotraqueal difícil em pacientes obesos mediante a comparação dos laringoscópios Macintosh e Airtraq(r). Métodos: em 132 pacientes de cirurgia bariátrica foram registrados: perímetro cervical, distância esternomentoniana, distância inter-incisivos e escore de Mallampati. Os pacientes foram randomizados em dois grupos, de acordo com o laringoscópio usado para a intubação traqueal: Macintosh (n = 64) ou Airtraq(r) (n = 68). O tempo até a intubação foi o primeiro desfecho. Também foram registrados: escore de Cormack-Lehane, número de tentativas de intubação, lamina Macintosh usada, necessidade de compressão traqueal externa, ou uso de um bougie elástico de borracha. Também foram anotados o insucesso na intubação e as estratégias adotadas. Resultados: houve insucesso na intubação em dois pacientes no grupo com laringoscópio de Macintosh; esses pacientes foram incluídos como o pior cenário de caso. Os tempos para intubação foram 36,9 ± 22,8 seg e 13,7 ± 3,1 seg para os grupos Macintosh e Airtraq(r) (p < 0,01), respectivamente. Os escores de Cormack-Lehane também foram mais baixos para o grupo Airtraq(r). Um paciente no grupo Macintosh com insucesso na intubação foi rapidamente intubado com o laringoscópio Airtraq(r). A circunferência cervical (p < 0,01) e a distância inter-incisivos (p < 0,05) influenciaram o tempo até a intubação no grupo Macintosh, mas não no grupo Airtraq(r). Conclusão: em pacientes obesos, apesar da maior circunferência cervical e da limitada abertura da boca, o laringoscópio Airtraq(r) possibilita uma intubação traqueal mais rápida versus laringoscópio Macintosh, podendo funcionar como alternativa, nos casos de insucesso com a laringoscopia convencional.

Palavras-chave

Obesity, Intubation, Laryngoscopy, Airtraq(tm), Obesidade, Intubação, Laringoscopia, Airtraq(r)

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