GlideScope® videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation

Background: Awake fiberoptic intubation is the gold standard for management of predicted difficult intubation. The purpose of this study was to test whether Glide Scope video laryngoscopy (GVL) will provide significant advantages over fiberoptic bronchoscopy (FOB) for awake intubation in morbidly obese patients with predicted difficult intubation. We therefore tested the hypothesis that intubation using GVL is faster than intubation with FOB. Methods: 64 morbidly obese patients with predicted difficult intubation undergoing laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned to receive awake oral intubation by either GVL or FOB. After airway topical anesthesia and sedation using target controlled remifentanil infusion to a Ramsay sedation scale of 3, wee compared the two devices for time to intubate, successful intubation on first attempt, glottic view using Cormack and Lehane score system, response of the patient to scope, patients satisfaction and incidence of postoperative sore throat and hoarseness. Results: Intubation time was 84±37.9 seconds and 73.6±31.1 seconds for FOB and GVL respectively. 75% of patients were successfully intubated on the first attempt with FOB compared to 80.6% with GVL. Grade I/II glottic view was reported with GVL in 96.7% of patients compared to 100% with FOB. The highest target concentration of remifentanil to maintain patients sedated during intubation was 2.4±0.6 ng/ml and 2.2±0.8 ng/ml in FOB and GVL respectively. No significant differences regarding maximum patient response to intubation, adverse effects or patient satisfaction were recorded between groups. Conclusion: GVL can be used as a useful alternative to FOB in morbidly obese patients with predicted difficult intubation.