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2 results

  • Videolaryngoscopy improves intubation condition in morbidly obese patients

  • J. Marrel, C. Blanc, P. Frascarolo, L. Magnusson
  • Journal:
    European Journal of Anaesthesiology / Volume 24 / Issue 12 / December 2007
    Published online by Cambridge University Press:
    01 December 2007, pp. 1045-1049
    Print publication:
    December 2007
  • Background and objective

    Tracheal intubation may be more difficult in morbidly obese patients (body mass index >35 kg m−2) than in the non-obese. Recently, new video-assisted intubation devices have been developed. After some experience with videolaryngoscopy, we hypothesized that it could improve the laryngoscopic view in this specific population and therefore facilitate intubation. The aim of this study was to assess the benefit of a videolaryngoscope on the grade of laryngoscopy in morbid obesity.

    Methods

    We studied 80 morbidly obese patients undergoing bariatric surgery. They were randomly assigned to one of two groups. One group was intubated with the help of the videolaryngoscope and in the control group the screen of the videolaryngoscope was hidden to the intubating anaesthesiologist. The primary end-point of the study was to assess in both groups the Cormack and Lehane direct and indirect grades of laryngoscopy. The duration of intubation, the number of attempts needed as well as the minimal SPO2 reached during the intubation process were measured.

    Results

    Grade of laryngoscopy was significantly lower with the videolaryngoscope compared with the direct vision (P < 0.001). When the grade of laryngoscopy was higher than one with the direct laryngoscopy (n = 30), it was lower in 28 cases with the videolaryngoscope and remained the same only in two cases (P < 0.001). The minimal SPO2 reached during the intubation was higher with the videolaryngoscope but it did not reach statistical significance.

    Conclusions

    In morbidly obese patients, the use of the videolaryngoscope significantly improves the visualization of the larynx and thereby facilitates intubation.

  • How to inform a morbidly obese patient on the specific risk to develop postoperative pulmonary complications using evidence-based methodology

  • S. Flier, J. T. A. Knape
  • Journal:
    European Journal of Anaesthesiology / Volume 23 / Issue 2 / February 2006
    Published online by Cambridge University Press:
    20 January 2006, pp. 154-159
    Print publication:
    February 2006

  • Summary

    Background and objective: Patients have the right to be informed about the expected benefits and risks of medical and surgical procedures. Ideally this information should be scientifically based and presented to the patient in time. In morbidly obese patient undergoing general anaesthesia, postoperative pulmonary complications are an important cause of postoperative morbidity and mortality. A 46-yr-old female with a body mass index of 89.8 kg m−2 was scheduled to undergo radical abdominal surgery for cervix carcinoma. In order to inform her accurately on the risk of developing postoperative pulmonary complications, we undertook to answer the following question: What is the risk to develop postoperative pulmonary complications in a morbidly obese patient about to undergo abdominal surgery under general anaesthesia? Methods: A Medline search was conducted from 1966 to 2004 with respect to postoperative pulmonary complications in abdominal surgery of morbidly obese patients. Altogether, 213 articles were found, of which seven were selected. Additionally, seven cross-references and or related articles were used. Results: For obese patients who undergo abdominal surgery under general anaesthesia, the likelihood to develop atelectasis is 10.4 ± 4.8% (P < 0.001) with a correlation coefficient of 0.28–0.34 (P < 0.05). The likelihood to develop atelectasis and pneumonia taken together is 29.3% with an adjusted odds ratio of 2.82 (95% confidence interval 1.66–4.78; P = 0.0001). Conclusion: Considering the positive correlation coefficient and the high body mass index of this patient she has a risk of at least 29.3% to develop pneumonia and/or atelectasis, which should affect the anaesthetic strategy in this patient.