The main objective of this study was to examine the relationship between classical markers used in assessing difficult airway management in obese patients (Mallampati score, thyromental distance, sternomental distance, neck circumference measurement) and ultrasonographic parameters (vocal cord mobility, glottic opening, hyomental distance, skin-epiglottic distance, and peri-epiglottic space-epiglottic-vocal cord ratio), to compare the effects of these parameters on predicting difficult intubation, and to investigate the effects of different laryngoscopy methods on intubation success and peroperative respiratory complications.
The secondary objective of the study is to investigate the effects of different laryngoscopy methods on hemodynamic responses to intubation. Participants' gender, age, height, weight, BMI, ASA physical status classification, smoking status, comorbidities, STOP-BANG and LEMON scores will be recorded. The glottic score percentage (POGO score), glottic visualization time, endotracheal intubation time, use of assistive maneuvers, and Intubation Difficulty Scale (IDS) parameters will be compared according to the laryngoscopy methods used.
Participants must meet the following criteria:
* Consent given by the patient * Operated under general anesthesia * Over 18 years of age * American Society of Anesthesiologists (ASA) physical status classification I-II-III * Body mass index (BMI) of 30 kg/m2 or higher * Operation duration between 60-150 minutes * Patients undergoing elective surgery.
Patients who have given their consent
Patients who underwent surgery under general anesthesia
Patients over eighteen years of age
Patients with an American Society of Anesthesiologists (ASA) physical status classification of I-II-III
Patients who do not consent,
those undergoing head and neck surgery,
those to be operated on in the prone position,
uncooperative patients (patients with whom communication is not possible),
Parallel
Airway ultrasonography
Procedure/SurgeryPreoperative airway ultrasonography will be performed in the waiting area before surgery to evaluate upper airway structures including vocal cord mobility, glottic opening, hyomental distance, skin-to-epiglottis distance, and peri-epiglottic space-epiglottis-vocal cord ratio. Measurements will be obtained with a Mindray Consona N7 ultrasound device while the patient is in the supine position. Each measurement will be performed three times and the average value will be recorded. Postoperative airway ultrasonography will be repeated at 30 minutes in the recovery unit.
Macintosh Laryngoscope Intubation
DeviceEndotracheal intubation will be performed using a conventional Macintosh direct laryngoscope under standardized general anesthesia induction.
Tuoren Videolaryngoscope Intubation
DeviceEndotracheal intubation will be performed using the Tuoren videolaryngoscope under standardized general anesthesia induction.
Besdata Videolaryngoscope Intubation
DeviceEndotracheal intubation will be performed using the Besdata videolaryngoscope under standardized general anesthesia induction.
Prediction of difficult tracheal intubation
Airway ultrasonographic parameters and conventional airway assessment scores will be evaluated to determine their ability to predict difficult tracheal intubation in obese patients undergoing elective surgery under general anesthesia. Difficult tracheal intubation will be defined using the Intubation Difficulty Scale (IDS).
Tracheal intubation success according to laryngoscope type
Tracheal intubation success will be compared among patients randomized to Macintosh laryngoscope, Tuoren videolaryngoscope, and Besdata videolaryngoscope during tracheal intubation in obese patients undergoing elective surgery under general anesthesia.
Glottic visualization time
Glottic visualization time will be defined as the time from passage of the laryngoscope blade past the lips until the first visualization of the vocal cords during laryngoscopy. Glottic visualization time will be compared among the Macintosh laryngoscope, Tuoren videolaryngoscope, and Besdata videolaryngoscope groups.
Endotracheal intubation time
Endotracheal intubation time will be defined as the time from passage of the laryngoscope blade past the lips until confirmation of successful tracheal intubation by capnography. Intubation time will be compared among the Macintosh laryngoscope, Tuoren videolaryngoscope, and Besdata videolaryngoscope groups.
Hemodynamic response to tracheal intubation
Hemodynamic parameters will be recorded before anesthesia induction, 1 minute after induction, at 1, 3, 5, and 10 minutes after tracheal intubation, and immediately before extubation to evaluate the effects of different laryngoscopy techniques.
Postoperative airway ultrasonographic measurements
Airway ultrasonography will be repeated 30 minutes after extubation in the recovery unit and compared with preoperative ultrasonographic measurements.
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