Awake Video Stylet Airway Assessment and Evaluation of Tracheal Intubation With CMAC D-Blade Versus Video Stylet in Bariatric Surgery

N/ACompletedNCT06981923

General Committee of Teaching Hospitals and Institutes, Egypt350 enrolled

Overview

Patients undergoing bariatric surgery often present challenges during intubation due to limited neck mobility, increased soft tissue in the airway, and elevated body mass index (BMI). Predicting difficult intubation in these patients is critical to ensuring safety. The Simplified Airway Risk Index (SARI) by Ganzouri is a validated tool for predicting difficult intubation. It considers factors like neck mobility, Mallampati score, and body weight, which are highly relevant in difficult airway prediction in the bariatric population. The CMAC video laryngoscope is widely used to manage difficult airways. Two commonly used devices are the CMAC D-Blade, designed explicitly for difficult airways, and the CMAC Video stylet, which combines video guidance with a flexible tip. This study will compare the efficacy and safety of these two devices in bariatric patients with an anticipated difficult airway, as identified by the SARI.

Standard monitoring will be attached. Preoperative awake airway assessment: after airway topicalization, CMAC Video stylet will be used for airway assessment, and the Cormack and Leane and percentage of glottic view will be recorded. Induction of Anesthesia: A standardized protocol will be followed for all patients, including preoxygenation and administration of propofol, fentanyl, and muscle relaxants (e.g., rocuronium). Intubation: The intubating anesthetist will use the assigned device. Rescue Strategy: If intubation fails after three attempts or exceeds 120 seconds, the anesthetist will switch to an alternative device or follow the institutional difficult airway protocol.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

350

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients (≥ 18 years) * BMI ≥ 35 kg/m² * SARI score ≥ 4 * Scheduled for elective bariatric surgery Exclusion Criteria: 1. SARI score \< 4. 2. any known or suspected airway pathology (such as tumors, airway trauma, or history of airway surgery/tracheostomy). 3. Emergency surgery. 4. Coagulopathy. 5. seizures, pregnancy, 6. mouth opening ≤ 2 cm. 7. contraindications to general anesthesia or neuromuscular blockade and uncooperative patients.