Anesthesia in obese patients is associated with difficult mask ventilation, rapid desaturation, and difficult intubation1,2. Practice guidelines for management of the difficult airway reported by the
American Society of Anesthesiologists (ASA) advise that ‘multiple airway features should be assessed’3.
EL-Ganzori simplified risk index (EGRI) combines and stratifies seven variables derived from parameters and observations individually associated with difficult intubation, a score more than 4 has been used as the definition of difficult intubation in different populations4. In spite of the development of numerous airway devices in the past two decades, a recent British survey concluded that difficulty with tracheal intubation is …show more content…
FOBs are expensive, and their proper use requires extensive training and practice. The presence of edema, excess airway tissue, secretions, or blood in the pharynx or larynx makes FOB assisted intubation of the trachea difficult, or even impossible6.
The GlideScope® videolaryngoscope (GVL) has been in clinical use since 20037. It has been shown to facilitate tracheal intubation by means of improving laryngeal view in several studies covering a wide spectrum of general surgical patients7,8. Furthermore, it has been proven superior to direct laryngoscopy in patients with predicted difficult intubation9,10.
The aim of the present study is to compare the efficacy of awake tracheal intubation by GVL to FOB in morbidly obese patients with predicted difficult intubation scheduled for laparoscopic bariatric surgery.
Patient selection and randomization
The study was approved from the human research committee (Security Force hospital, Riyadh, KSA) and written informed consent was obtained from all subjects prior to inclusion. Over one year, 64 patients undergoing laparoscopic bariatric surgery were enrolled in this prospective clinical