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

Abstract

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) I-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 Visual Analogue Scale (VAS), haemodynamics, and complications. 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 were comparable in number of attempts with standard technique (47 1st /3 2nd attempt) and reverse manoeuvre (49 1st /1 2nd attempt). Obese group with reverse manoeuvre all were intubated with first attempt (50 1st) with standard technique (46 1st /1 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.