Video Laryngoscopes in Obesity-

Highlights

• •It remains unclear whether videolaryngoscope is superior to Macintosh laryngoscopy for intubation in obese patients.
• •There are no meta-analyses comparing videolaryngoscopes and Macintosh laryngoscopes for intubation in obese patients.
• •Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted.
• •Videolaryngoscopes were superior to Macintosh laryngoscopes for tracheal intubation in obese patients.

Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis

• Hiroshi Hoshijima, DDS^a, ,  (Assistant Professor), 
• Yohei Denawa, MD^b (Resident), 
• Asako Tominaga,MD^a (Instructor), 
• China Nakamura, MD^a (Instructor), 
• Toshiya Shiga, MD^c (Professor),

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https://doi.org/10.1016/j.jclinane.2017.11.008

Study objective

Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity.

Design

Systematic review, Meta-analysis

Setting

Operating room, Obesity patients

Measurements

Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI).

Main results

Eleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR = 1.11, 95% CI 1.04 to 1.18, p = 0.001, I2 = 63%, Intubation time; WMD = −16.1, 95% CI −31.1 to −1.10, p = 0.04, I2 = 97%, Glottic visualisation; RR = 1.19, 95% CI 1.09 to 1.30, p < 0.0001, I2 = 76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel.

Conclusions

Videolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity