Modified-ramped position: a new position for intubation of obese females: A randomized controlled study.

Abstract

Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position (modified-ramped position) during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization Methods Sixty obese females scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the modified-ramped position (n=30), the patient shoulders were elevated using special pillow, and the head was extended to the most possible range. Our primary outcome was incidence of failure of laryngoscope insertion in the oral cavity due to large breast with the need to repositioning “elevation of the patient’s shoulder during intubation”. Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of mask ventilation, and Cormack-Lehane grade for laryngeal view. Results Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscopy in comparison to one patient (3%) in the modified-ramped position (p<0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position. Conclusion Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position