OBESITY AND ANTICIPATED DIFFICULT AIRWAY- A COMPREHENSIVE APPROACH WITH VIDEOLARYNGOSCOPY, RAMP POSITION, SEVOFLURANE AND OPIOID FREE ANAESTHESIA

Background: Anaesthetic management of obese patient can be challenging because of altered anatomy and physiology. Safe apnea period is extremely short and videolaryngoscope is believed to reduce the number of failed intubation attempts. Slow emergence with fat-soluble volatile agents may be due to delayed release from adipose stores. Use of opioids in the presence of obesity increases the occurrence of obstructive sleep apnea, hypoxia and upper airway obstruction. The aim is to provide safe airway management in obesity by reducing the number of intubation attempts and the time taken for intubation with reduced post-operative respiratory depression. Methods: 25 patients with the BMI of >30kg/m2 were selected. Standard technique for induction of anaesthesia using Inj. Dexmedetomidine 1mcg/kg 10 mins before intubation with patient in RAMP position was done. HugeMed videolaryngoscope with appropriate sized blade was used and maintainance of anaesthesia with Sevoflurane and Inj. Dexmedetomidine 0.5mcg/kg/hr. Assessment consisted of number of intubation attempts, time required for intubation, visualisation of glottis, hemodynamic stress response to laryngoscopy and intubation and post-operative respiratory depression. Results: Among 25 patients, 18 patients had intubation at the first attempt, the maximum attempts taken were three in 2 patients. In majority of the patients i.e, 10, time taken for intubation was 13-15 secs. The maximum time to intubate was 18-20 secs in 2 patients. The visualisation if glottic structures assessed by Percentage Of Glottic Opening (POGO) score was 80-100% in majority of 20 patients. Most of the patients had a saturation of 96-100% post-operatively. There was a significant fall in the above hemodynamic parameters from baseline to intubation and 5mins later. The mean reduction in HR was 28.42%, SBP- 28.72%, DBP- 38.85% and MAP- 34.69%. Conclusion: This study emphasises on the use of advanced airway tools, standard intubation techniques and careful drug selection in order to prevent and minimise the risk of airway complication in obesity.