Comparison of Intubation Success Rates of 3 Different Laryngoscope Blade Types in Morbidly Obese Patients
Condition: Intubation;Difficult; Morbid Obesity
MeSH terms: Obesity, Morbid
Study type: Interventional

Summary: 
      Reusable laryngoscope blades, which are the most commonly used devices for airway management,
      have been reported to be frequently contaminated and a possible source of infection. Although
      disposable laryngoscope blades are recommended to reduce the risk of infection, there are
      studies suggesting increased failed intubation attempt rates.

      The major cause of anesthesia-related mortality and morbidity is the failure of airway
      management. The incidence of difficult airway is reported to be 1-4% in normal population
      while it ranges up to 12-20% in obese patients. Following the introduction of disposable
      blades and considering the increased rate of failed intubation in obese patients with these
      devices, the investigators aimed to make a comparison of successful intubation rates of
      plastic and metallic disposable blades in morbidly obese patients
    

Detailed description: 
      Successful airway management is the first and most important step of patient safety in
      anesthesia practice, and most common reason of morbidity and mortality related to anesthesia
      is failure to provide optimum airway safety.

      Intubation helps the anesthesiologist have complete control over airway by keeping airway
      open, facilitating control over ventilation, reducing the risk of aspiration and providing
      safe airway during resuscitation, and laryngoscopes are most commonly used tools for this
      purpose. Laryngoscope are comprised of a handle and a blade (also contains light source)
      which are mostly reusable. But these parts are easily contaminated during intubation,
      creating susceptibility to infection. Some studies report that even handles have a chance of
      50% to be contaminated with blood. Insufficiently disinfected blades are also a major source
      of infection. Laryngoscopes contact with non-intact mucous membranes and blood frequently,
      thus play an important role in cross contamination. Abramson et al. reported that 1/3 of
      reusable laryngoscope blades are contaminated with bacteria after multiple uses. Concerns
      about hygiene and risk of infection (including prion infections) caused many health
      professionals tend towards use of disposable medical devices. Following their introduction,
      single use laryngoscope blades have been subject to many studies, and many opinions were
      discussed in different platforms. In studies in which intubation success rates of metallic
      reusable, metallic disposable and plastic disposable blades were compared, while some have
      demonstratedd their success rates to be identical, others concluded that plastic disposable
      blades were ineffective compared to two other.

      Laryngoscopy and endotracheal intubation may not be easily performed in every case. Airway
      management and endotracheal intubation are easier in non-obese patients compared to obese
      patients. Short and relatively immobile neck, narrow interincisor distance, hypertrophic
      tonsillae, uvula and adenoids in obese patients makes intubation more difficult in these
      patients. Additionally, loss of muscle tonus causes tongue to obstruct airway and epiglottis
      to touch posterior wall of pharynx, thus obstructing airway further.

      The investigators couldn't find any study conducted on obese patients evaluating success
      rates for intubation of metallic reusable, metallic disposable and plastic disposable blades
      in the literature. In this study, they aimed to compare intubation success rates of metallic
      reusable, metallic disposable and plastic disposable blades in intubation of obese patients.
    

Intervention name(s): endotracheal intubation
Intervention type(s): Device
Intervention description(s): patients were intubated with 3 different blades
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Intubation; obesity; disposable blade