From the Departments of Outcomes Research and General Anesthesiology.
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Anesth Analg. 2020 Aug;131(2):586-593. doi: 10.1213/ANE.0000000000004747.
Two-thirds of the US population is considered obese and about 8% morbidly obese. Obese patients may present a unique challenge to anesthesia clinicians in airway management. Videolaryngoscopes may provide better airway visualization, which theoretically improves intubation success. However, previous work in morbidly obese patients was limited. We therefore tested the primary hypothesis that the use of McGrath video laryngoscope improves visualization of the vocal cords versus Macintosh direct laryngoscopy (Teleflex, Morrisville, NC) in morbidly obese patients.
We enrolled 130 surgical patients, aged 18-99 years, with a body mass index ≥40 kg/m and American Society of Anaesthesiologists (ASA) physical status I-III. Patients were randomly allocated 1:1-stratified for patient's body mass index ≥50 kg/m-to McGrath video laryngoscope versus direct laryngoscopy with a Macintosh blade. The study groups were compared on glottis visualization, defined as improved Cormack and Lehane classification, with proportional odds logistic regression model.
McGrath video laryngoscope provided significantly better glottis visualization than Macintosh direct laryngoscopy with an estimated odds ratio of 4.6 (95% confidence interval [CI], 2.2-9.8; P < .01). We did not observe any evidence that number of intubation attempts and failed intubations increased or decreased.
McGrath video laryngoscope improves glottis visualization versus Macintosh direct laryngoscopy in morbidly obese patients. Large clinical trials are needed to determine whether improved airway visualization with videolaryngoscopy reduces intubation attempts and failures.
三分之二的美国人口被认为肥胖，约 8%为病态肥胖。肥胖患者可能对麻醉临床医生的气道管理提出独特的挑战。视频喉镜可能提供更好的气道可视化，理论上提高插管成功率。然而，之前在病态肥胖患者中的研究有限。因此，我们检验了主要假设，即使用 McGrath 视频喉镜比 Macintosh 直接喉镜（Teleflex，Morrisville，NC）在病态肥胖患者中改善声带可视化。
我们纳入了 130 名年龄在 18-99 岁、体重指数≥40kg/m 和美国麻醉医师协会（ASA）身体状况 I-III 的手术患者。患者以 1:1 分层随机分配至 McGrath 视频喉镜组或 Macintosh 直接喉镜组（直型叶片）。使用比例优势逻辑回归模型比较两组的声带可视化（定义为改善的 Cormack 和 Lehane 分级）。
与 Macintosh 直接喉镜相比，McGrath 视频喉镜提供了显著更好的声带可视化，估计优势比为 4.6（95%置信区间 [CI]，2.2-9.8；P <.01）。我们没有观察到尝试插管次数和插管失败增加或减少的任何证据。
与 Macintosh 直接喉镜相比，McGrath 视频喉镜在病态肥胖患者中改善了声带可视化。需要进行大型临床试验以确定视频喉镜改善气道可视化是否减少插管尝试和失败。
