الفهرس 
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Abstract
Inability to successfully intubate the trachea remains a leading cause of anesthetic morbidity and mortality, notwithstanding recent development in airway management.
Difficult tracheal intubation is more common among obese than non-obese patients. Morbid obesity, defined as a body mass index (BMI)35 kg / m2 is found in about 1-2% of the population. is performed on selected patients whose obesity -unlike the patients with lesser degrees of obesity- has important implications to their health status with subsequent increase in morbidity and mortality.
The currently used laryngoscopy was introduced in the 20ties of the previous century. Its modification over time was not significant, and newdesigns were mainly to solve difficult intubation-related problems. An example of a classic (Macintosh) laryngoscope modification used for difficult intubation is the McCoy laryngoscope with a mobile blade, suitable for cases in which the flat epiglottis obscures the superior laryngeal aperture.
Even in the best hands, there are patients with anatomical characteristics that do not favor successful visualization of laryngeal structures. Furthermore, it is known that there is an irreducible number of patients, perhaps 8.5% in whom direct laryngoscope unexpectedly fails.
The Airtraq (Prodol Meditec SA, Vizcaya, Spain) a new disposable intubating device, was designed to provide a view of the glottis without alignment of the oropharyngeal , pharyngeal and laryngeal axes together.
The Airtraq laryngoscope (AL) has recently been used in patients with normal airways and in simulated difficult airways .The blade of the Airtraq consists of two side by side channels. One channel acts as the housing for the placement and insertion of the tracheal tube, and the other channel terminate in a distal lens. A battery operated light is present at the tip of the blade. The image is transmitted to a proximal view finder using a combination of lenses allow visualization of the glottis and surrounding structures and the tip of tracheal tube.
The aim of our study was to evaluate the usefulness of the Airtraq and classical Macintosh laryngoscopes for endotracheal intubation in morbidly obese patients.
A written informed consent was obtained from all patients. Forty ASA I–II morbidly obese (BMI >35 kg / m2) adult patients were enrolled in this study. The patients were randomly assigned to two equal groups (20 patients in each group).
• Group1: Macintosh group (20 patients).
• Group2: Airtraq group (20 patients).
Exclusion criteria:
Patients with history of hiatus hernia. Symptomatic gastric reflux.Allergy to succinylcholine or any drug in this study.Mouth opening of less than 30 mm (interincisor distance).
Anesthetic technique:
Standard monitoring, including electrocardiography, non-invasive blood pressure, oxygen saturation measured by pulse oximetry, end tidal carbon dioxide were used in all patients. Patients were preoxygenated for 4 minutes using facemask and anesthesia was induced with fentanyl (1-1.5μg /
kg), propofol (2-3 mg / kg) and succinylcholine (1mg / kg). The patients were manually ventilated with oxygen 100% before tracheal intubation.
After tracheal intubation, atracurium (0.5mg / kg) was administered and anesthesia was maintained with isoflurane in oxygen and fentanyl (0.5μg /
kg) boluses.
from our study, the Airtraq resulted in reduced duration of intubation attempts, and reduced the scores of intubation difficulty scale. The Cormack and Lehane grading system, although originally designed to compare glottic views at direct laryngoscopy, provided a useful comparison of the direct and indirect laryngoscopic views achieved in this study, wheres thirteen patients intubated with the Airtraq had a grade 1 Cormack and Lehane glottic view, compared to four patients only in the Macintosh group. Fewer patients required additional maneuvers to improve glottic exposure with the Airtraq device. All patients who sustained a significant arterial oxygen desaturation were in the Macintosh group. The lowest SaO2 values were seen in the situation where more than one attempt at tracheal intubation was required and where bag-mask ventilation had become suboptimal.
The Airtraq resulted in less stimulation of heart rate and blood pressure post tracheal intubation in comparison with the Macintosh laryngoscope. In fact, the Airtraq produced minimal hemodynamic stimulation in these patients. Our findings probably reflects the fact that the Airtraq provides a view of the glottis without a need to align the oral, pharyngeal and tracheal axes, and therefore requires less force to be applied during laryngoscopy.