Videolaryngoscope Versus Fiberoptic Bronchoscope for the Awake Intubation

Endotracheal intubation of the morbidly obese is often performed awake. Fiberoptic bronchoscope assisted endotracheal intubation, a commonly utilized technique for securing an airway while a patient is awake, has many limitations. The video laryngoscope is a device that is similar to a conventional laryngoscope but uses a video system to visualize the larynx. Because of its low cost, ease of use, and usefulness in the presence of edema or bleeding that may obstruct the airway, video assisted laryngoscopy has been shown to be useful for awake endotracheal intubations. However, a direct comparison of the fiberoptic bronchoscope with video assisted laryngoscopy has not been performed for awake endotracheal intubations in of obese patients. Patients undergoing laparoscopic gastric bypas andrecquiring awake intubations will be randomized for either fiberoptic bronchoscope or video assisted laryngoscopy. The investigators primary outcome will be the time required for successful intubation.

Inclusion Criteria:

• morbidly obese patient presenting for bariatric surgery at the Royal Victoria Hospital

Exclusion Criteria:

• moderate to severe systemic illness, i.e. American Society of Anesthesiologists (ASA) score of 4 or higher
• inability to communicate in English or French
• contraindications to the drugs used in the study