Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

Abstract

Video laryngoscopy (VL) is a well-established technique used in anaesthetising obese patients who present with higher risks of airway-related difficulties and desaturations due to shorter safe apnoea periods. However, VL has certain limitations and may fail. We present the Infrared Red Intubation System (IRRIS), a new technique facilitating glottis identification in severely obese patients undergoing anaesthesia for bariatric surgery. This single-centre, prospective trial assessed the efficacy of the IRRIS for VL tracheal intubation in 20 severely obese adult patients undergoing elective bariatric surgery under general anaesthesia. We assessed the ability of the IRRIS to differentiate the transilluminated glottis from the oesophagus and laryngeal folds and evaluated the ease of intubation. The average weight in the investigated patient cohort was 145 ± 29 kg, the suprasternal tissue thickness was 12 ± 4 mm. The median IQR [range] larynx recognition time was 10 [2-50] s, which was similar to that of lean patients. The degree of obesity correlated with the duration to achieve optimal laryngoscopic view and complete the intubation procedure. We achieved successful VL insertion on the first attempt in 13 of 20 cases (65%), and on the second attempt in 7 cases (35%), emphasising the increased probability of successful intubation on the first attempt. Tracheal intubation with the IRRIS lasted 50 [IQR 20-100] s. The lowest SpO2 during intubation was 98 [IQR 83-100] %. Addition of IRRIS to VL insertion facilitated the intubation of difficult airways in severely obese patients. IRRIS improves the visualization of the intubation pathway by selectively highlighting the airway entrance and shortens the time to successfully conclude the intubation procedure.

Portal Vein Thrombosis a Rare but Life-threatening Complication after Laparoscopic Sleeve Gastrectomy: A 5 Years Study in a Bariatric Center of Excellence

“…As a standard of attitude in out hospital, all the bariatric patients were treated according to a low opioid anesthesia and a multimodal non-opioid postoperative analgesia protocol. (15) All patients underwent LSG in reverse Trendelenburg with carbon dioxide insufflation pressure of 12-15mm Hg. Adequate dissection of the posterior aspect of the fundus and active search of the hiatal hernia are steps of our current surgical protocol for LSG.…”

Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup

“…It emits infrared blinking light, which penetrates the tissue; it is invisible to the naked eye but results in a visible bright blinking light on the video monitor screen of videolaryngoscopes and FBs that do not have infrared filters [31]. IRRIS has been shown to be safe and beneficial in the elective videolaryngoscope intubation of lean patients with normal airways [35], elective videolaryngoscope intubation of extreme obese patients [36], and elective awake tracheal intubation with FB in patients with known difficult airways [31,32]. e light emerging from the trachea facilitates the identification of the glottis and may be a tool that will make it easier to intubate the most difficult airways with pathology and distortion [31,32].…”

Infrared flashing light through the cricothyroid membrane to guide flexible bronchoscopic tracheal intubation

“…We found an additional two reports of the use of IRRIS in the literature [7, 8]. These reports demonstrated successful use of the technique for rigid video laryngoscopic tracheal intubation in lean [8] and obese [7] anaesthetised patients without airway pathology and suggested that time to tracheal intubation is reduced and first pass success is increased [8].…”