Obesity Clinical Trial
Official title:
Modified Ramped Position for Intubation of Obese Females: a Randomized Controlled Study
The aim of this work is to investigate the feasibility of using the modified a ramped position for intubation of obese females in comparison to the traditional ramped position.
Adequate conditions for endotracheal intubation require appropriate positioning of head and
neck. The sniffing position had been described as the most appropriate head position for
endotracheal intubation. Sniffing position is achieved through two main components: flexion
of the neck by 35° (achieved by head elevation) and extension of the head by 15° 2 to have
the sternum at the same level of external auditory meatus 34. Sniffing position has the
advantage of alignment of the three axes: oral, pharyngeal, and laryngeal axes for reaching
the optimal laryngeal visualization.
In obese patients, it is recommended to put the patient in the ramped position (back-up
position with the tragus of the ear is at the level of the suprasternal notch) in addition to
the sniffing head-and-neck position. Some commercially available pillows were introduced to
facilitate laryngoscopy in obese patients such as: Troop elevation pillow and Rapid airway
management positioner.
In addition to difficult laryngeal visualization, another problem commonly confronts
anesthetists during intubation of obese females; that is impedance of laryngoscopy by large
breasts. This problem commonly hinders the intubation process and might lead to serious
hypoxia. Most of the positions described in literature were concerned with facilitating
laryngeal visualization. No position to the best of our knowledge was applied to aid the
introduction of the laryngoscope in the presence of large breasts.
The investigators hypothesized that using a special pillow to achieve a modified ramped
position (by slight extension of the neck) at the beginning of the laryngoscopy would bring
the breasts away from the laryngoscope. After successful introduction of the laryngoscope in
the oral cavity, the head will be elevated using a head rest to achieve sniffing position.
The aim of this work is to investigate the feasibility of using the aforementioned modified
ramped position for intubation of obese females in comparison to the traditional ramped
position.
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