ABSTRACT
STUDY OBJECTIVE: To determine whether shoulder and head elevation, such that the patient's ear lies at or higher than the sternum ("ramp"), improves laryngoscopic grade in adult patients of various body mass index (BMI) values. DESIGN: Prospective, unblinded study, with patients and laryngoscopists acting as their own controls. SETTING: Operating room of a university-affiliated hospital. PATIENTS: 189 adult ASA physical status 1, 2, and 3 patients. INTERVENTIONS: After performing a standard preoperative airway evaluation and inducing general anesthesia, the anesthetist performed and graded two laryngoscopies: one in the "ramp" position and one in the "sniff" position. MEASUREMENTS: Patient BMI, Mallampati airway class, thyromental distance, neck circumference, cervical extension ability, Cormack and Lehane laryngoscopic grade for each laryngoscopy, subjective lifting force required, and need for external laryngeal pressure were recorded. MAIN RESULTS: Use of the "ramp" provided significantly better or equal laryngoscopic views, relative to those with the "sniff" position, in the entire study population. CONCLUSIONS: Shoulder and head elevation by any means that brings the patient's sternum onto the horizontal plane of the external auditory meatus maintains or improves laryngoscopic view significantly.
Subject(s)
Intubation, Intratracheal/methods , Laryngoscopy/methods , Obesity/complications , Posture , Adult , Anesthesia, General/methods , Body Mass Index , Head , Hospitals, University , Humans , Obesity, Morbid/complications , Shoulder , SternumABSTRACT
A 30-year-old man with a personal and family history of malignant hyperthermia and a 7-year history of psychiatric illness unresponsive to various psychotropic medications benefitted from electroconvulsive therapy given in combination with clozapine. Volatile inhalation anesthetics and a depolarizing muscle relaxant (succinylcholine) were assiduously avoided. Dantrolene was administered intravenously before the first treatment but was not used for the remainder of the treatments. Anesthesia was induced with methohexital and atracurium. The treatment course was uneventful.
