Quality Assessment of Orotracheal Intubation Without Neuromuscular Blocking Agents in Obese Patients

The prevalence of obesity increases steadily. For anesthesiologists, the airway management of obese patients is known to be difficult and at risk. Tracheal intubation needs to be successful quickly. Neuromuscular blocking agents allow this option but with a risk of anaphylaxis and respiratory complications. In fact, for many surgical procedures those drugs are not necessary.

Numerous studies in non-obese patients with the combination of Remifentanil and Propofol have shown adequate conditions for tracheal intubation without neuromuscular blocking drugs. This combination has never been studied in obese patient.

After randomization, induction of general anesthesia will be performed with 2,5 mg/kg of Propofol in association with either 3 µg/kg of Ideal Body Weight of Remifentanil, or 3 µg/kg + 30% of Ideal Body Weight of Remifentanil.

Minutes after the induction, orotracheal intubation will be performed, and the Intubation Difficulty Scale recorded.

Other data on hemodynamic, respiratory and airway management will be are collected during the surgery.

In the Post Anaesthetic Care Unit (PACU),Any symptoms of traumatic airway management or aspiration are collected.

Those data will be again looked for and collected on the day of the patient's discharge.

Inclusion criteria

• Patient over 18 and under 60 years old.
• ASA score ≤ 3
• Elective bariatric surgery for patient with BMI between 35 and 60 or elective revision of a bariatric surgery for patient with a BMI over 30.
• Patient with a written consent obtained with accurate information.

Exclusion criteria

• Patient with risk of aspiration
• Difficult airway known (Cormack score 3 ou 4).
• Opioids addiction.
• Alcoholism
• Chronic use of Opioids
• Confirmed Allergy to Propofol or Remifentanil
• Severe chronic hepatic, kidney or respiratory failure
• Patient already enrolled in another clinical study interfering with this study.