Comparison between Standard Technique versus Reverse Manoeuvre of Airtraq Insertion for Tracheal Intubation in Lean versus Obese Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study
Dr. Latika Laxmichand Dharmashi,
W/o Dr Kiran Biradar #239/57, Near Lions School Extension Area, 1st Cross Vinayak Nagar, Near Spandana Hospital, Bagalkot-587101, Karnataka, India.
Introduction: Obese patients pose challenge to anaesthesiologist in terms of securing airway due to large tongue and anatomical variations, need a novel tracheal intubation technique to quickly secure airway in obese individuals. The airtraq laryngoscope with reverse technique of insertion is used to secure airway without classical sniffing position.
Aim: To compare the two techniques of airtraq insertion, standard and reverse manoeuvre, in lean versus obese patients undergoing surgery under general anaesthesia.
Materials and Methods: This randomised clinical study was conducted from July 2012 to January 2014 at Seth GS Medical College and KEM Hospital, Mumbai, Maharasthra, India in a total of 200 American Society of Anaesthesiologists (ASA) physical status I to III undergoing surgery under general anaesthesia. Both lean and obese patients were randomly allocated to each technique. After induction of anaesthesia intubation was performed by an expert anaesthesiologist with each technique (three attempts) were used to intubate trachea. If there was a failure, switch over technique was applied. All the groups were analysed for intubation time, number of attempts, ease of intubation assessed by Visual Analogue Scale (VAS), haemodynamics, and complications. Data entry was done on a Microsoft Excel sheet and data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 15.0.
Results: Both lean and obese groups were comparable in the airway and demographic characteristics. In lean patients there was no significant difference between intubation time with both standard and reverse manoeuvre. While in obese patients reverse manoeuvre (11.84±1.99 seconds) significantly reduced exposure time by 13 seconds as compared to standard technique (24.02±6.94 seconds), thereby reducing total duration of intubation (26.08±1.16 seconds) as compared to total duration of intubation with standard technique (39.62±8.95 seconds). Lean group was comparable in number of attempts with standard technique (47 patients in 1st attempt/3 patients in 2nd attempt) and reverse manoeuvre (49 patients in 1?supst attempt/1 patient in 2nd attempt). Obese group with reverse manoeuvre all were intubated with first attempt (50 patients) with standard technique (46 patients in 1st attempt/1 patient in 2nd attempt) and there was switch over from standard to reverse technique in three patients. Both lean and obese groups were comparable in complications with both technique.
Conclusion: Reverse manoeuvre proved beneficial in obese patients as it reduced intubation time as compared to standard technique, while lean patients showed no difference.