Airway management for morbidly obese patients: a comparativestudy between fiberoptic bronchoscopes and intubatinglaryngeal masks

BackgroundObesity is an epidemic disease that continues to increase in most countries. It is estimated that more than 30% of the adult population is obese. Airway management in morbidly obese adults may be a challenge to anesthesiologists due to anatomical and physiological changes that affect obese patients. The intubating laryngeal mask airway (ILMA) is a new device specifically designed to be an effective ventilator device and blind intubation guide in patients with normal and abnormal airways. The aim of this study was to compare the effectiveness and the safety of the ILMA technique with fiberoptic intubation (FOI) in obese patients with an anticipated difficult intubation.Patients and methodsEighty morbidly obese adult patients of either sex, aged 18–60 years, with BMI more than 40 kg/m2, with anticipated difficult intubation, and ASA physical status I–III, were scheduled for elective bariatric abdominal surgery, which required tracheal intubation and general anesthesia, in Mansoura University Hospital. Patients were randomly allocated into two groups: the FOI and the ILMA group. Randomization of the groups was performed by a computerized method, with 40 patients in each group. Anesthesia was induced with intravenous propofol 2–3 mg/kg of ideal body weight and fentanyl (2 mg/kg). Anesthesia was maintained with a propofol infusion (10 mg/kg/h). Patient characteristics such as age, sex, BMI, and the ASA class, heart rate and noninvasive blood pressure (NIBP), oxygen saturation, the success or failure rate, the number of attempts, and the duration of the successful attempt were all recorded.ResultsPatients in the ILMA and the FOI groups were comparable to each other regarding the duration of intubation and the success rate. However, complications were significantly lower in the ILMA group than in the FOI group.ConclusionILMA may be a good alternative device for FOI for tracheal intubation in morbidly obese patients.