Tracheal intubation with the McGrath MAC X-blade videolaryngoscope in morbidly obese and nonobese patients

Zehra Ipek Arslan,Hadi Ufuk Yörükoğlu

doi:10.3906/sag-1901-169

Abstract

Background/aimIncreased body mass index (BMI) and neck circumference are the two independent predictors of difficult intubation. McGrath MAC X-Blade is a videolaryngoscope specifically designed for difficult intubations.Materials and methodsEighty patients with the American Society of Anesthesiologists (ASA) physical status I–III undergoing elective surgery requiring endotracheal intubation were enrolled in the study. Patients were divided into two groups, nonobese (BMI < 30) and morbidly obese (BMI > 35). All patients were intubated with the McGrath MAC X-Blade in both groups. View optimization and tube insertion maneuvers such as reinsertion of the device, slight removal of the device, cricoid pressure, handling force, 90° anticlockwise rotation of the tube, use of stylet, and head flexion maneuvers were recorded. Cormack–Lehane grades, insertion times, intubation, and total intubation times were recorded. The hemodynamic changes and postoperative minor complications were also recorded.ResultsBody mass index, neck circumference, Mallampati scores, and ASA physical status were statistically higher in the morbidly obese group (P < 0.001 and P < 0.05). Sternomental distances were shorter in the morbidly obese (P < 0.05). Cormack–Lehane grades were comparable among the groups. The morbidly obese patients required more reinsertion attempts and cricoid pressure maneuvers during intubation than the nonobese patients (P = 0.019 versus P = 0.012, respectively). Slight removal of the device, handling force, use of the stylet, 90° anticlockwise rotation of the tube, and head flexion maneuvers were also helpful in both groups. Although device insertion times were similar between the groups, intubation and total intubation times were longer in the morbidly obese group (P = 0.009 and P = 0.034, respectively). The groups were comparable in hemodynamic changes and postoperative minor complications.ConclusionThe McGrath MAC X-Blade videolaryngoscope could safely be used both in nonobese (BMI < 30) and morbidly obese (BMI > 35) patients with the aid of some key maneuvers and with a statistically significant but clinically negligible prolongation of the intubation time.

Highlights

The Fourth National Audit Project of the Royal College of Anesthetists and the Difficult Airway Society reported a 4-fold increase in major airway events in obese patients [1]
The American Society of Anesthesiologists (ASA) guidelines for the management of a difficult airway recommend the use of video laryngoscopes (VLs) in unexpected difficult intubations
Demographic and airway variables, and teeth morphology were recorded

Summary

Introduction

The Fourth National Audit Project of the Royal College of Anesthetists and the Difficult Airway Society reported a 4-fold increase in major airway events in obese patients [1]. Dixit et al [2] demonstrated that Cormack–Lehane 3–4 is higher in morbidly obese patients than in lean patients. Increased body mass index (BMI) and neck circumference are the two independent predictors of difficult intubation [3]. Most of the difficult airways are unexpected [4]. The anesthetists must minimize multiple attempts at tracheal intubation [5]. The American Society of Anesthesiologists (ASA) guidelines for the management of a difficult airway recommend the use of video laryngoscopes (VLs) in unexpected difficult intubations

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Results

Conclusion