• Ralph Maassen, Ruben Lee, André van Zundert, and Richard Cooper.
• Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven 5623 EJ, The Netherlands.
• J Anesth. 2009 Jan 1;23(3):445-8.

AbstractThis report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. Based upon the obesity of the patient and preoperative metrics (Mallampati grade IV; interdental distance of 2.9 cm; thyromental distance, 5.5 cm) a difficult airway was anticipated. Classic direct laryngoscopy using a Macintosh blade size IV failed, despite three intubation attempts-each resulting in a Cormack-Lehane grade IV view. Intubation using a video-assisted Macintosh laryngoscope (V-Mac; Karl Storz, Tuttlingen, Germany) was successful upon the first attempt. The maximum force exerted on the patient's maxillary incisors was 61 N by direct laryngoscopy and 7.6 N using the indirect videolaryngoscope, both using a Macintosh blade.

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