Awake Nasal Fiber-optic Intubation of Severely Obese Patients in Lateral Position
Condition: Anesthesia; Intubation;Difficult; Intubation; Difficult or Failed; Anesthesia Intubation Complication
Study type: Interventional

Summary: 
      Airway management in severely obese patients remains a challenging issue for anesthetists and
      may lead to life-threatening situations. Awake Fiber-Optic Bronchoscopy Intubation (FOBI)
      technique is considered as the gold standard when a difficult airway is anticipated to secure
      the airway and to facilitate the surgery. FOBI is usually done in supine position, while (in
      conscious patients) lateral position is the most recommended position to keep the upper
      airway patent. This prospective clinical trial study will test whether awake FOBI in Lateral
      position will provide a safe profile or a significant advantage over FOBI in supine position,
      in morbidly obese patients undergoing elective bariatric surgery.
    

Detailed description: 
      Airway management in severely obese patients remains a challenging issue for anesthetists and
      may lead to life-threatening situations. Awake Fiber-Optic Bronchoscopy Intubation (FOBI)
      technique is considered as the gold standard when a difficult airway is anticipated to secure
      the airway and to facilitate the surgery. FOBI is usually done in supine position, while (in
      conscious patients) lateral position is the most recommended position to keep the upper
      airway patent.

      This prospective clinical trial study will test whether awake FOBI in Lateral position will
      provide a safe profile or a significant advantage over FOBI in supine position, in morbidly
      obese patients undergoing elective bariatric surgery. The main outcome is success rate and
      duration of the procedure. Secondary outcomes are oxygenation maintenance, hemodynamic
      stability, airway complication, sedation score, and postoperative airway morbidity in 6 hours
      after surgery.
    

Intervention name(s): Fiberoptic intubation in supine position.; Fiberoptic intubation in lateral position.
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients will be placed in supine position after the establishment of full vital signs monitoring and the insertion of an intravenous line.
Under sedation via intravenous infusion of remifentanil plus topical anesthesia with 10 ml of Lidocaine 1% via a 3.7mm bronchoscope. After applying a standard monitoring and preparation of the nose by decongestant and local anesthesia. A loaded flexible scope (by an endotracheal tube ETT) will be introduced through the nostril to reach the carina, then the ETT will be pushed over the scope 3cm above the carina.; Patients will be placed in lateral position after the establishment of full vital signs monitoring and the insertion of an intravenous line.
Under sedation via intravenous infusion of remifentanil plus topical anesthesia with 10 ml of Lidocaine 1% via a 3.7mm bronchoscope. After applying a standard monitoring and preparation of the nose by decongestant and local anesthesia. A loaded flexible scope (by an endotracheal tube ETT) will be introduced through the nostril to reach the carina, then the ETT will be pushed over the scope 3cm above the carina.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Anesthesia; Intubation; obesity; fiberoptic