MODIFIED UNIVERSAL RAMP VERSUS INFLATABLE RAMP FOR CONVENTIONAL LARYNGOSCOPY IN OBESE PATIENTS: A RANDOMIZED COMPARATIVE STUDY

Abstract

Background:There are several alterations that exist within the structure of obese patients due to which the risk of difficult laryngoscopy becomes high. Although the use of ramp devices for better optimization of positioning is associated with improvement in conditions for intubation, there exists no comparison of Modified Universal Ramp versus Inflatable Ramp till date. Objectives:  A comparative study of the effectiveness of Modified Universal Ramp and Inflatable Ramp for improving glottic view (as determined by Cormack–Lehane grading) and ease of intubation on a 5-point Likert scale using conventional laryngoscopy technique in obese subjects. Methods: One prospective randomized comparative study in a single-blind method was carried out at Saveetha Medical College and Hospital. Sixty obese patients (BMI> 30kg/ m2) undergoing elective surgeries under general anesthesia were randomly allocated into two groups (30 patients each). The first group (Group A) had patients with Modified Universal Ramp (MUR) while the second group had Inflatable Ramp. Assessment of CL grade and laryngoscopy (using 5-point Likert Scale) were the primary objectives. Statistical analysis of results involved Chi-Square Test (p-value <0.05) Results: Both groups were comparable in age, BMI, gender, and ASA status. In the Modified Universal Ramp group, 56.7% of patients achieved CL Grade I and 43.3% Grade II, with no Grade III views. In the Inflatable Ramp group, no patients achieved Grade I, 50.0% were Grade II, and 50.0% were Grade III (p = 0.01). Ease of laryngoscopy was rated as 'easy' or 'very easy' in all Modified Universal Ramp patients, compared to 50.0% 'difficult' and 50.0% 'not difficult' in the Inflatable Ramp group (p = 0.03). Conclusion: The Modified Universal Ramp demonstrates greater glottic visibility and easy laryngoscopy as opposed to the Inflatable Ramp, especially during laryngoscopy among obese patients. The Modified Universal Ramp is stable and enables airway alignment easily; therefore, it is more likely to be used among obese patients.