Using supraglottic airway devices for awake blind tracheal intubation of obese patients
Background. The respiratory tract control in adult patients with obesity can be a very difficult task for an anesthesiologist. To prevent hypoxemia and aspiration during anesthesia induction, the method of awake intubation is used in obese patients. The purpose of our study was to evaluate the effectiveness and safety of using the supraglottic airway devices (SAD) ILMA and I-Gel for this procedure. Materials and methods. The prospective non-randomized study included 26 patients with body mass index > 30 kg/m2 that had awake tracheal intubation using ILMA (88 %) or I-Gel (22 %) after mild sedation and local anesthesia of the airways. For every patient, the risk of severe intubation was evaluated; time and number of attempts of successful installation of SAD and successful tracheal intubation through SAD were determined; heart rate, noninvasive blood pressure, SpO2 were measured during the procedure; the presence of bleeding, pain and discomfort after surgery were recorded. Statistical analysis was conducted using Student’s t-test, Mann-Whitney U-test and χ2-test. Results. Nineteen (73 %) patients had a risk of severe intubation according to Mallampati test, and 5 (19 %) individuals — according to inability to unbend the neck for more than 80°. In all cases, SAD were installed from the first attempt during 20 (15–30) s. For successful intubation through SAD, 1–2 attempts with duration of 10 (5–20) s were needed (p < 0.05). During the procedure, SpO2 within 90–95 % was noticed in 8 (31 %) patients, SpO2 < 90 % was not detected at all (p < 0.05). At the stable blood pressure, tachycardia up to 101 ± 13 bpm was recorded only when tube was inserted into the trachea (p < 0.05). After the surgery, 20 (81 %) patients reported the presence of blood in the sputum, 18 (69 %) — a mild discomfort from procedure itself, 7 (27 %) — a moderate discomfort, 1 (4 %) patient — significant discomfort (p < 0.05). Conclusions. Awake intubation through the ILMA and I-Gel is a simple, effective and safe technique of airway management in obese patients.
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