General Anestesi Intubation Technique in Tonsillectomy Patients with Morbid Obese

Authors

Keywords:

Choronic tonsillitis, tonsillektomy, anesthesia, ramp position

Abstract

Using the descriptive case method, this study examined general anesthesia intubation procedures in tonsillectomy patients who were severely obese. Obesity, which is a worldwide health problem, impacts anesthesia procedures, especially when intubating patients with large necks, such as the study participants. The modified RAMP technique decreased the risk of respiratory complications, improved visualization of the larynx, and established ideal positioning. Although there are some drawbacks, such as inadequate equipment, the study findings suggest that the RAMP position may make intubation easier in obese patients.

References

1. Yanto F, Sudjana IG. Anestesia perioperatif pada pasien obesitas morbid dengan gangguan tidur. Medicina (B Aires). 2019;50(3):438–41.

2. Saraf A, Manhas M, Manhas A, Kalsotra P. Obesity and ENT manifestations — a tertiary care centre study. Egypt J Otolaryngol [Internet]. 2023;39(1). Available from: https://doi.org/10.1186/s43163-023-00378-3

3. Hasanin A, Tarek H, Mostafa MMA, Arafa A, Safina AG, Elsherbiny MH, et al. Modified-ramped position : a new position for intubation of obese females : a randomized controlled pilot study. 2020;1–7.

4. Nur’aini RD. Penerapan Metde Studi Kasus Yin Dalam Penelitian Arsitektur dan Prilaku. INERSIA. 2020;16(8):935–51.

5. Risdayani E, Makmun A. Hubungan Obesitas dengan Usia, Jenis Kelamin, Genetik, Asupan Makanan dan Kebiasaan di Dusun Bangkan. Indones J Heal. 2021;2(01):55–67.

6. Midah Z, Fajriansyah F, Makmun A, Rasfahyana R. Hubungan Obesitas dan Stress Oksidatif. UMI Med J. 2021;6(1):62–9.

7. Gita Zeny Prasetya1, Aryu Candra1 DMK. Pengaruh Suplementasi Seng Terhadap Kejadian Tonsilitis Pada Balita. 2018;7:186–94.

8. Putu Jaya Wiratama1*, Didit Yudhanto2 BTD. SEBUAH TINJUAN PUSTAKA: TONSILITIS KRONIS. 2022;04(02):3244–50. Available from: file:///C:/Users/HP/AppData/Local/Microsoft/Windows/INetCache/IE/950I9HYJ/599-Article Text-1290-1-10-20230119[1].pdf

9. Siti Sapura, Fahrizal Fahrizal. Sebuah Kasus : Post Tonsilektomi Dengan Komplikasi Syok Hipovolemik. J Gen Heal Pharm Sci Res. 2023;1(4):10–7.

10. Rehatta N margarita, Dito E hanin, Tantri AR, S.Redjeki I, R.F.Soenarto, Bisri DY, et al. Anestesiologi dan Terapi Intensif. PT gramedia Pustaka Utama; 2019.

11. Kelly G, Najoan RR, Mengko, K. S. Karakteristik Pasien Operasi Tonsilektomi di RSUP Prof Dr. R. D. Kandou Manado. e-CliniC. 2016;4(1):299–305.

12. Lee S, Jang EA, Hong M, Bae HB, Kim J. Ramped versus sniffing position in the videolaryngoscopy-guided tracheal intubation of morbidly obese patients: a prospective randomized study. Korean J Anesthesiol. 2023;76(1):47–55.

13. Brambillasca P, Benigni A, Maffioletti M, Sonzogni V, Lorini LF, Corbella D. Anesthetics considerations in peritonitis. J Peritoneum (and other serosal surfaces). 2017;2.

14. Semler MW, Janz DR, Russell DW, Casey JD, Lentz RJ, Zouk AN, et al. A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults. Chest. 2017;152(4):712–22.

15. Nikolla DA, Beaumont RR, Lerman JL, Datsko JS, Carlson JN. Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position. JACEP Open. 2020;1(3):257–62.

16. Thangaswamy chitra R, Elakkumanan LB. Ramp Position for intubting morbidly obese parturient: What’s new ? Indian J Anaesth. 2011;55(2):205–6.

17. Cattano D, Melnikov V, Khalil Y, Sridhar S, Hagberg CA. An evaluation of the rapid airway management positioner in obese patients undergoing gastric bypass or laparoscopic gastric banding surgery. Obes Surg. 2010;20(10):1436–41.

18. Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, et al. Preoxygenation is more effective in the 25° head-up position than in the supine position in severely obese patients: A randomized controlled study. Anesthesiology. 2005;102(6):1110–5.

19. Collins JS, Lemmens HJM, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: A comparison of the “sniff” and “ramped” positions. Obes Surg. 2004;14(9):1171–5.

20. Lee JH, Jung HC, Shim JH, Lee C. Comparison of the rate of successful endotracheal intubation between the “sniffing” and “ramped” positions in patients with an expected difficult intubation - A prospective randomized study. Korean J Anesthesiol. 2015;68(2):116–21.

Downloads

Published

2025-01-04

Issue

Section

ICHBS Proceedings

How to Cite

General Anestesi Intubation Technique in Tonsillectomy Patients with Morbid Obese. (2025). Proceeding ICHBS, 1(1), 338-344. https://ichbs.uhb.ac.id/index.php/proceeding/article/view/46