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Research article
changsong wang
Harbin Medical University Cancer Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0079-5259
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Background: The airway management of obese patients is complex, and intubation is a critical step. Therefore, it is important to choose the optimal laryngoscope. Moreover, the best type of laryngoscopes to use for this population is unclear. The aim of this study was to determine the optimal laryngoscopes for endotracheal intubation in obese patients. Methods: We searched the Cochrane, Medline, EMBASE, EBSCOhost and Web of Science databases for randomized controlled trials comparing video laryngoscopes (VLs) with direct laryngoscopes (DLs) or different brands of VLs in adults with obesity for inclusion in this study. First-attempt success rate, intubation time, glottic view and composite complications were identified in this meta-analysis. Results: A total of 13 trials with 1264 patients were identified. VLs were associated with an increase in the first-attempt success rate (relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.16), shorter intubation time (mean difference (MD) -13.19, 95% CI -25.57 to -0.81) and an improved glottic view (RR 1.24, 95% CI 1.17-1.30). No difference was observed in the incidence of composite complications. In the network meta-analysis, all three types of VLs (Macintosh blade VLs, angulated blade VLs and side-channel blade VLs) were associated with an improved glottic view (RR 1.4, 95% credible interval (CrI) 1.2-1.7; RR 1.3, 95% CrI 1.2-1.5; and RR 1.2, 95% CrI 1.1-1.3, respectively). Conclusions: Compared with DLs, VLs generally showed advantages in obese patients requiring endotracheal intubation. Despite the composite complications, there is insufficient evidence to definitively identify the optimal type of laryngoscopes in obese patients. Angulated blade VLs reduce the complications related to intubation compared with side-channel blade VLs and conventional Macintosh DLs. Trial registration: This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017079927. http://www.crd.york.ac.uk/PROSPERO).
Keywords
Obesity; laryngoscopes; meta-analysis
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A new preprint design is coming!
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
changsong wang
Harbin Medical University Cancer Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0079-5259
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 2
Posted 27 Jun, 2019
No community comments so far
No comments provided
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine Specialties
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The airway management of obese patients is complex, and intubation is a critical step. Therefore, it is important to choose the optimal laryngoscope. Moreover, the best type of laryngoscopes to use for this population is unclear. The aim of this study was to determine the optimal laryngoscopes for endotracheal intubation in obese patients. Methods: We searched the Cochrane, Medline, EMBASE, EBSCOhost and Web of Science databases for randomized controlled trials comparing video laryngoscopes (VLs) with direct laryngoscopes (DLs) or different brands of VLs in adults with obesity for inclusion in this study. First-attempt success rate, intubation time, glottic view and composite complications were identified in this meta-analysis. Results: A total of 13 trials with 1264 patients were identified. VLs were associated with an increase in the first-attempt success rate (relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.16), shorter intubation time (mean difference (MD) -13.19, 95% CI -25.57 to -0.81) and an improved glottic view (RR 1.24, 95% CI 1.17-1.30). No difference was observed in the incidence of composite complications. In the network meta-analysis, all three types of VLs (Macintosh blade VLs, angulated blade VLs and side-channel blade VLs) were associated with an improved glottic view (RR 1.4, 95% credible interval (CrI) 1.2-1.7; RR 1.3, 95% CrI 1.2-1.5; and RR 1.2, 95% CrI 1.1-1.3, respectively). Conclusions: Compared with DLs, VLs generally showed advantages in obese patients requiring endotracheal intubation. Despite the composite complications, there is insufficient evidence to definitively identify the optimal type of laryngoscopes in obese patients. Angulated blade VLs reduce the complications related to intubation compared with side-channel blade VLs and conventional Macintosh DLs. Trial registration: This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017079927. http://www.crd.york.ac.uk/PROSPERO).
Figure 1
Figure 2
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Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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