• Minerva anestesiologica · Mar 2016

    Near-zero difficult tracheal intubation and tracheal intubation failure rate with the "Besta Airway Algorithm" and "Glidescope® in morbidly obese" (GLOBE).

    • Elena Cagnazzi, Alessandro Mosca, Federico Pe, Tiziana Togazzari, Ottavia Manenti, Francesco Mittempergher, Elena Raffetti, Francesco Donato, and Nicola Latronico.
    • Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University, Hospital, Brescia, Italy - elenacagnazzi@gmail.com.
    • Minerva Anestesiol. 2016 Mar 17.

    BackgroundUnpredicted Difficult Tracheal Intubation (DTI) with Macintosh occurs frequently in obese patients. We investigated the incidence of DTI using an algorithm based on pre-operative assessment with the El-Ganzouri Risk Index (EGRI) and Glidescope® routine use.MethodsWe prospectively enrolled morbidly obese patients undergoing abdominal surgery. Patients were scheduled for Glidescope® intubation under general anesthesia if EGRI was <7 or awake Flexible Fiber-optic Intubation if EGRI was ≥7. The primary outcome was the DTI rate, defined as Cormack and Lehane grades ≥III, Intubation Difficulty Scale >5 and modified Intubation Difficulty Scale >5. Secondary outcomes included intubation success on the first attempt, the Time to Cormack, the Time to Intubation, failure to intubate, oxygen desaturation and difficult ventilation.ResultsOf the 214 patients enrolled, 212 (99%) were intubated with Glidescope® and 2 (1%) with awake Flexible Fiber-optic Intubation (one electively, one after a Glidescope® failure). There were no cases of DTI assessed using Cormack and Lehane and Intubation Difficulty Scale, and 3 cases (1.4%; 95% C.I. 0.45%-4,29%) assessed using modified Intubation Difficulty Scale. Of the 213 patients intubated with Glidescope®, 185 (87%) had successful intubation on the first attempt. Mean Time to Cormack and Time to Intubation were 13.1 (SD 9.6) and 38.1 seconds (SD 21.1) respectively. We had one case (0.5%) of failed Glidescope® intubation and no cases of clinically significant complications.ConclusionsThe incidence of Difficult Tracheal Intubation and Intubation Failure was reduced to near-zero using Glidescope® and the Besta Airway Algorithm in this sample of morbidly obese patients.

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