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Clinical evaluation of the C-MAC D-Blade videolaryngoscope in severely obese patients: a pilot study

2012; Elsevier BV; Volume: 109; Issue: 4 Linguagem: Inglês

10.1093/bja/aes333

1471-6771

Davide Cattano, Ruggero M. Corso, A.V. Altamirano, Chirag B. Patel, M.M. Meese, C. Seitan, Carin A. Hagberg,

Respiratory Support and Mechanisms

Editor—Morbidly obese patients often have a large neck circumference that necessitates special positioning for intubation and reduced posterior airway space that could lead to improper mask ventilation.1Kristensen MS Airway management and morbid obesity.Eur J Anaesthesiol. 2010; 27: 923-927doi:10.1097/EJA.0b013e32833d91aaCrossref PubMed Scopus (71) Google Scholar 2Collins JS Lemmens HJ Brodsky JB Brock-Utne JG Levitan RM Laryngoscopy and morbid obesity: a comparison of the ‘sniff’ and ‘ramped’ positions.Obes Surg. 2004; 14: 1171-1175doi:10.1381/0960892042386869Crossref PubMed Scopus (270) Google Scholar Videolaryngoscopy provides superior views compared with traditional laryngoscopy in both normal and difficult intubation situations and is relatively easy to use, making it potentially advantageous for this type of patient.3Hagberg C Vogt-Harenkamp CC Bogomolny Y Ellis S Nguyen TV A comparison of laryngoscopy techniques using the video laryngoscope and the traditional Macintosh laryngoscope in potentially difficult to intubate patients.Anesth Analg. 2005; 100: S-212Google Scholar 4Asai T Videolaryngoscopes: do they truly have roles in difficult airways.Anesthesiology. 2012; 116: 515-517doi:10.1097/ALN.0b013e318246e866Crossref PubMed Scopus (76) Google Scholar We performed a pilot study to evaluate the performance of the C-MAC D-Blade videolaryngoscope (Karl Storz, Tuttlingen, Germany) in severely obese patients and to test the hypothesis that the C-MAC D-Blade would enable a superior view of the glottic structures, and also provide faster tracheal intubations than the C-MAC blade. After approval from the institutional board of the University of Texas Medical School at Houston, 50 morbidly obese (BMI ≥40 kg m−2) ASA I–III patients who underwent elective surgeries at Memorial Hermann Hospital-Texas Medical Center (Houston, TX, USA) provided written consent. The patients were randomized into either a group that underwent laryngoscopy first with the C-MAC followed by a secondary laryngoscopy with the C-MAC D-Blade and then tracheal intubation with the D-Blade or a group that underwent laryngoscopy first with the C-MAC D-Blade then laryngoscopy with the C-MAC and then tracheal intubation with the C-MAC. Intubations were performed by second- and third-year residents (CA-2 and CA-3). The time required to obtain optimum view [modified Cormack–Lehane (CL) grade score],5Yentis SM Lee DJ Evaluation of an improved scoring system for the grading of direct laryngoscopy.Anaesthesia. 1998; 53: 1041-1044doi:10.1046/j.1365-2044.1998.00605.xCrossref PubMed Scopus (234) Google Scholar time required to intubate, and the number of attempts were recorded. The time to the optimal view of the glottis was defined as the time from the moment the anaesthesiologist had the laryngoscope in hand to time to optimal visualization of vocal cords. Intubation time was defined as the time from which the anaesthesiologist had a tracheal tube (TT) in hand to when the TT cuff passed distally through the vocal cords. Data were compared by the Mann–Whitney U-test (continuous variables) and χ2 test (categorical variables) using Stata (Stata Corp., College Station, TX, USA). Times were reported as median (1st inter-quartile, 3rd inter-quartile). Comparisons were considered statistically significant if P 1 attempt to intubate (n)00N/AFog/secretions6 (12%)0%0.01 Open table in a new tab Overall, the study had negative results. We did not find statistically significant differences in time to optimal view of the glottis, time of intubation, or number of attempts. Several studies have confirmed that the use of the C-MAC system is safe and provides comparable results, in comparison with direct laryngoscopy, for laryngoscopy and intubation.6Cavus E Neumann T Doergas V et al.First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation.Anesth Analg. 2011; 112: 382-385doi:10.1213/ANE.0b013e31820553fbCrossref PubMed Scopus (89) Google Scholar 7Cattano D Maddukuri V Altamirano A et al.Initial experience with Karl Storz C-Mac video intubation system.Anesthesiology. 2011; : A1062Google Scholar Although morbid obesity does not constitute a difficult airway per se, it can constitute a serious event in a patient population (mild to severe desaturation). Taking into consideration the limitations of a pilot study, we found that the D-Blade provided a good view of the glottis, which resulted in fast and successful tracheal intubation during routine induction of anaesthesia in severely obese patients, possibly anticipating advanced usage in more serious and difficult situations. D.C. has been granted funds from Storz (Germany) to continue research on the C-MAC system. C.A.H. is a paid consultant for Storz (Germany).