Article

Airway management using the intubating laryngeal mask airway for the morbidly obese patient

Department of Anesthesiology and Intensive Care, European Hospital Georges Pompidou, Paris, France.
Anesthesia & Analgesia (Impact Factor: 3.42). 06/2003; 96(5):1510-5, table of contents. DOI: 10.1213/01.ANE.0000057003.91393.3C
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Philippe Cadi, Dec 15, 2014
0 Followers
 · 
137 Views
  • Source
    [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 · 2.17 Impact Factor
  • Source
    [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.
    Anesthesiology Clinics 10/2006; 24(3):621-36. DOI:10.1016/j.atc.2006.05.003
  • [Show abstract] [Hide abstract]
    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    35(1):63-73.