We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients scheduled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 +/- 5 kg/m(2)). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then inserted, and the trachea was intubated through the ILMA by a second observer. The rate of successful tracheal intubation with ILMA was 96.3%. The success rate, the number of attempts, and the total duration of the procedure were not different among patients with low-grade (Cormack 1-2) and patients with high-grade (Cormack 3-4) laryngeal views. The time required for insertion of the ILMA was slightly longer in patients with high-grade laryngeal views. Failures of the technique were not explained by the experience of the practitioner or airway characteristics. No adverse effect related to the technique was reported. Results of this study suggest that using the ILMA provides an additional technique for airway management of morbidly obese patients. IMPLICATIONS: The intubating laryngeal mask airway (ILMA) provides an additional technique for airway management of morbidly obese patients. The best choice of the primary technique (laryngoscopy or ILMA) for tracheal intubation of an adult obese patient remains to be determined.
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"The difficulty of repositioning a morbidly obese patient during a failed intubation should not be underestimated, and proper positioning is often not understood or perceived by practitioners who are not experienced in airway management in obese patients. If direct laryngoscopy is unsuccessful, laryngeal mask airways are effective for establishing ventilation and should be immediately available . The prevention or reduction of atelectasis from the induction and maintenance of general anesthesia would improve arterial oxygenation. "
[Show abstract][Hide abstract] ABSTRACT: The global obesity epidemic presents anesthesia providers with unique and complex challenges as an increasing number of patients with elevated body mass index present for medical care. Pharmacokinetics, respiratory and cardiac physiology, positioning, regional anesthetic techniques, monitoring, and postoperative care are all profoundly affected by increased body mass. In recent years, the occult impact of undiagnosed obstructive sleep apnea on perioperative morbidity and mortality has marshaled increased attention from both patients and practitioners. A summary and discussion of the Practice Guidelines developed by the American Society of Anesthesiologists regarding the care of patients with obstructive sleep apnea is provided.
Clinics in chest medicine 10/2009; 30(3):569-79, x. DOI:10.1016/j.ccm.2009.05.009 · 2.07 Impact Factor
"Recent studies, however, have described the highly successful use of an alternate airway device called the intubating laryngeal mask airway (ILMA). In MO patients, successful tracheal intubation was achieved 96% of the time through this device on first attempt . In a separate report , a comparison was made of the success rate of intubating the trachea with the ILMA in an MO group versus a lean control group . "
[Show abstract][Hide abstract] ABSTRACT: The anesthetic management of the MO patient requires an important focus on a number of issues beginning with a careful preoperative evaluation and synthesizing pre-existing disease processes with the anesthetic management plan. The common misperception that all MO patients are "full stomach" has been challenged and may be a nonissue. New approaches to pre-oxygenation to lessen the likelihood of desaturation during apnea may be a valuable tool if difficulty is encountered in tracheal intubation. In addition, promising results have been demonstrated with the use of the ILMA for ventilation and for blindly establishing tracheal tube placement. Proper patient positioning is essential to aid in successful intubation when a laryngoscope is employed. Intraoperative anesthetic management can be guided with a processed electroencephalogram monitor to help improve emergence and to enhance wakefulness in the PACU. Careful consideration must be given to postoperative analgesic needs by minimizing the use of opioids and employing nonopioid analgesics including NSAIDs, alpha2-adrenergic agonists, and low doses of ketamine.
"The efficacy of the ILMA for ventilation and blind intubation has been reported in emergency patients with normal airways, and its use could be learnt quickly . The ILMA has been used successfully in patients with difficult airways [38,41,43,44] and in obese patients . Moreover, a comparably high success rate for tracheal intubation was observed with the ILMA in comparison with the fiberscope technique, but the ILMA was found to be associated with less adverse events than the fiberscope – in particular, oxygen desaturation . "
[Show abstract][Hide abstract] ABSTRACT: Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway.