Obesity, Airway Clinical Trial
Official title:
Evaluation of the Efficiency of I-gel Supraglottic Airway Device in Mechanical Ventilation in Supine and Lateral Decubitus Position in Obese Patient;Prospective Observational Study
Obesity is linked to many complications of respiratory care which are directly related to the
obstructive apnea syndrome: difficult airway management including difficult mask ventilation,
difficult intubation and obstruction of the upper airway.
I gel which is a non inflatablesupraglottic airway device with a gastric channel is gaining
popularity in anesthesia practice because of its ease of insertion and stable positioning.
There are many studies evaluating I-gel for airway managment during different head and necks
position ,in prone and lateral position showing both successeful results. Morover, it was
evaluated during spontanous and mechanically ventilated patients.
There are limited number of studies evaluating the efficacy of I- gel in mild to moderate
obese patients.
The primary aim of this study is to Measure the oropharyngeal airway leak pressure in both
supine and lateral position and to determine laryngeal glottic view grade by the fibreoptic
bronchoscope.
prospective observational cohort study. Induction of anethesisa will be started after
pre-oxygenating the patient for 3min , with administerating Propofol (2mg/kg)(lean body
weight)), Fentanyl (2μg/kg) and Atracurium (0.5mg/kg)(based on ideal body weight.The patient
will to be ventilated by a 100% oxygen and 1.2% isoflurane with fresh gas flow 6L/min for 5
min.immediately after induction heart rate , blood pressure and oxygen saturation will be
recorded.
A proper sized I-gel according to the patient's weight and manifacturer instructions
(Intersurgical Ltd, UK) ( 4 or 5 adult sizeI-gel) will be lubricated with a water based
lubricant from the front and back sides of the device, will be inserted after compelete
muscle relaxation (Train of four = zero) In case of insertion problem various adjuvant
manoeuvres will be used such as such as head flexion or extension, or slightly pulling or
pushing the device. Any additional manoeuvres will be recorded. If insertion or ventilation
fails three times in succession, Endotracheal tube will be immediately inserted and the
patient will be excluded from the study. The number of excluded cases will be recorded The
circut will be connected to the device,Capnograph will be attached and end tidal carbon
dioxide will be recorded.
The ventilator parameters will be set with tidal volume (4-6 ml/kg) at a respiratory
rate(12-15 breath/min) to maintain ETCO2 from 30-35 mmHg.
Anaethesia will be maintanied by a mixture of 50% oxygen and 50% medical air,Isoflurane 1.2%
and Atracurium (0.01 mg/kg) will be given according to train of four . Analgesia of pethidine
100mg IV will be given as intraoperative analgesia.
In order to confirm proper positioning of the I-gel,a fiberoptic bronchoscope will be pass
through the device and pushed forward up to1 cm proximal to it to obtain a glottic view.
Afterwards the same patient will be placed in the lateral decubitus position.Blood
pressure,Heart rate ,Oxygen saturation and End tidal CO2 will be recorded immedialy. After
confirming proper ventilation as before ,confirmation of I-gel position using fiberoptic
bronchoscope will be done and recorded.The leak air way pressure test will be done as
previously done in supine position and recorded.
The patient will be returned to supine position where a proper size Orogastric tube will be
inserted.The surgery can be started and Heamodynamics and ventilation will be monitored.
By the end of the surgery the patient will be reversed from general anaesthesia by
administrating Neostigmine (0.04mg/kg) and Atropine (0.01mg/kg). intravenously at (TOF=3) and
the I-gel will be removed at the end.The presence of blood on the I-gel device, or the
occurrence of any complications, will be recorded.
The patient will be transfered to the post operative care unit
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