الفهرس 
Introduction and aim of the work
Obesity and implication on anaesthesiaOnly 14 pages are availabe for public view
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Abstract
Airway management of morbidly obese patients is considered to be a true challenge to anaesthetist due to associated anatomical and physiological changes of those patients that affect mask ventilation and tracheal intubation. Respiratory system affection such as reduction of total lung capacity as well as function residual capacity which lead to rapid desaturation after induction of anaesthesia with higher incidence than occur in normal persons, as, well as the CVS, CNS. Many previous studies tried to optimize tracheal intubation in morbid obese patients without complication which are life threatened complications. This prospective randomized study evaluated the efficacy of two airway management devices in patients with morbid obesity. Fiberoptic bronchoscope (FOB) which considered the gold stone in airway management with anticipated difficulty. Intubating Laryngeal Mask Airway (ILMA) which is effective device for intubation and ventilation. We studied eighty patients with morbid obesity ,their age between 18 -60 years of either sex, and ASA physical status 1-3whom underwent surgery under genral anaesthesia with orotracheal intubation. We exclude patients with system pathology (renal, hepatic or respiratory), patients receiving anticoagulant,or whom with known history of allergy to local anaesthetic, or whom with impossible intubation. They were randomally allocated into either FOBI group or ILMA group. Both devices FOB or ILMA were prepared on nearby table inside the operative room. 20 minutes before induction of anaesthesia, the patient receive anxiolytic (midazolam 0.05 mg/ kg of IBW, and atropin 0.03 mg /kg IBW. to reduce secretions which may affect visualization during airway management .Upper airway topical anaesthesia was done by Lidocaine 0.5% to reduce gaging during airway instrumention with FOB or ILMA .Propofol 2-3mg/kg, fentanyl used for induction of anaestheia, propofol infusion for patients to achieve good intubation conditions with maintainance of spontenous breathing as difficulty of tracheal intubation is expected .. Mallapatti classification, neck circumference, thyromental distance, BMI, of all patients recorded and their relation to the success rate of tracheal intubation with every device befor induction of anaesthesia. Anaesthesia was maintained with sevoflurane, after successful tracheal intubation Patients were monitored by HR, MAP and SPO2 throughly the procedure. The success rate of tracheal intubation, number of attempts for successfal tracheal intubation, duration for tracheal intubation in both groups were recorded. Oxygen saturation, haemodynamic changes and complication that associated with airway management. Our results showed that oxygen saturation during airway management with ILMA was better than that with FOB as well as the duration of successfal tracheal intubation was shorter with ILMA than with FOB. As regards to the complication such as mucosal injury and bleeding and oesophegeal intubation came higher with FOB more than that with ILMA. Some studies support our results while other studies come in contrast with us. Whatever,from our results the ILMA may be a usefal alternative device for FOB in airway management of morbid obese patients . ILMA as supraglootic airway device for tracheal intubation in morbid obese achieved high success rate with shorter duration, little complication with better ventilation and preservation of oxygen saturation. While fiberoptic bronchoscope intubation of morbid obese patient achieved a high success rate also but associated with more complication and longer duration that are not significantly different than that of ILMA group So, we can conclude that ILMA may be an alternative device for FOB for tracheal intubation of morbid obese patients.