Indian Journal of Anaesthesia

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 64  |  Issue : 8  |  Page : 681--687

Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study


Wan Yen Lim1, Stephanie Fook-Chong2, Patrick Wong1 
1 Department of Anaesthesiology, Singapore General Hospital, Singapore
2 Department of Health Services Research, Singapore General Hospital, Singapore

Correspondence Address:
Dr. Wan Yen Lim
Singapore General Hospital, Outram Road, Singapore - 169608
Singapore

Background and Aims: Airway management in obese patients is associated with increased risk of difficult airway and intubation. After failed intubation, supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI) may be required. It is uncertain whether SAGFBI is best performed in the ramped versus conventional supine “sniffing air” position. We conducted a feasibility study to evaluate the logistics of positioning, compared glottic views, and evaluated SAGFBI success rates. Methods: We conducted a prospective, pilot study in patients with a body mass index (BMI) 30–40 kg/m2 undergoing elective operations requiring tracheal intubation. All patients were placed in a ramped position. After induction, a supraglottic airway device (SAD) was inserted. A flexible bronchoscope was inserted into the SAD and a photograph of the glottic view taken. The patient was repositioned to the supine position. A second photograph was taken. SAGFBI was performed. Images were randomised and assessed by two independent anesthetists. Results: Of 17 patients recruited, 15 patients were repositioned successfully. There were no differences in glottic views observed in the two positions. SAGFBI was successful in 92.9% of patients (median time 91.5 s). Haemodynamic changes were noted in 42.7% of patients which resolved spontaneously. Conclusion: Our pilot study was completed within 5 months, achieved low dropout rate and protocol feasibility was established. SAGFBI was successfully and safely performed in obese patients, with a median time of 91.5 s. The time taken for SAGFBI was similar to awake intubation using FBI and videolaryngoscopy. Our study provided preliminary data supporting future, larger-scale studies to evaluate glottic views in the ramped versus supine positions.


How to cite this article:
Lim WY, Fook-Chong S, Wong P. Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study.Indian J Anaesth 2020;64:681-687


How to cite this URL:
Lim WY, Fook-Chong S, Wong P. Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study. Indian J Anaesth [serial online] 2020 [cited 2020 Aug 12 ];64:681-687
Available from: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2020;volume=64;issue=8;spage=681;epage=687;aulast=Lim;type=0