RESUMO
PURPOSE: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq™ laryngoscopes. METHODS: from 132 bariatric surgery patients (body mass index ≥ 35 kgm(-1)), cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n=64) or an Airtraq™ (n=68) laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. RESULTS: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9+22.8s and 13.7+3.1s for the Macintosh and Airtraq™ laryngoscope groups (p<0.01), respectively. Cormack-Lehane scores were also lower for the Airtraq™ group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq™. Cervical circumference (p<0.01) and interincisor distance (p<0.05) influenced the time required for intubation in the Macintosh group but not in the Airtraq™ group. CONCLUSION: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq™ laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.
Assuntos
Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Obesidade/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Masculino , Pescoço , Obesidade/fisiopatologia , Fatores de TempoRESUMO
BACKGROUND AND OBJECTIVES: Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT). METHODS: We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n=100) or the laryngeal mask airway group (LMA, n=104). It was measured the level of oxygen saturation by pulse oximetry (SpO(2)) after the induction of anesthesia (SpO(2)-1), after establishing the operative field (SpO(2)-2), at the end of the surgical procedure (SpO(2)-3), three minutes after the removal of the contained breathing apparatus (SpO(2)-4) and upon admission to the post-anesthesia care unit (SpO(2)-5). All respiratory complications were recorded. RESULTS: The mean SpO(2) values and standard deviations for the TT and LMA groups were as follows: SpO(2)-1: 98.9±1.0 and 98.7±0.8 (p>0.25), SpO(2)-2: 97.4±1.0 and 94.9±4.3 (p<0.001), SpO(2)-3: 96.9±1.1 and 97.2±1.1 (p=0.037), SpO(2)-4: 91.7±9.0 and 95.2±2.2 (p<0.001) and SpO(2)-5: 94.0±2.1 and 95.8±2.6 (p<0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a TT. Respiratory complications were similar between groups. CONCLUSIONS: Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO(2), compared to using a TT. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a TT is preferred for safety.