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

Abstract

Background/aim: Increased 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 methods: Eighty 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. Results: Body 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. Conclusion: The 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.

Styletubation in Bariatric Surgery: A Case Report

“…Intuitively, one would think the VL to be superior to the DL in such scenario. The advantages of VL have been demonstrated by proponents of the method and include better glottic visualization, shorter intubating time, less intubation attempts, or higher intubation success rates [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Therefore, they proposed that the VL be used as the overall first-line tracheal intubation modality versus Macintosh DL in obese patients (and perhaps for overall patient populations to be intubated).…”

“…VL has been shown to possess certain advantages over the DL, including better glottic visualization, less need for the alignment of the airway axes, less force and cervical spine manipulation, shorter intubation time, and perhaps a higher first-pass success rate of intubation [ 18 , 19 ]. A plethora of literature show the advantages (e.g., easier, faster, less complications) of using VL in obese populations [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. However, the superiority of VL over DL, regarding all the outcome parameters (e.g., speed, safety, visualization, easiness), has not always been consistently confirmed in the obese patient population [ 31 , 32 , 33 , 34 ].…”

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…Still, it is a general consensus that morbid obesity makes tracheal intubation difficult [109]. There are various intubating modalities for obese patients [115][116][117][118][119][120] and VL is superior to conventional DL [121][122][123][124][125][126][127][128][129][130]. VS is useful in morbid patients due to its improved visualization of the larynx and the ease with tube advancement [131,132].…”

In reply: Comparing performance of McGrath MAC videolaryngoscope in morbidly obese and nonobese

“…

To the Editor, First of all, I would like to thank the Editor for giving me the chance to reply in this 'Letter to the Editor' regarding our newly published article called 'Tracheal intubation with the McGrath MAC X-Blade videolaryngoscope in morbidly obese and nonobese patients' [1]. Additionally, I am also grateful to the authors for their didactic diagnosis and for having given priority to the airway management of an obese patient consistent with our manner as well.

…”