Difficult tracheal intubation in morbidly obese patients

ABSTRACT Background Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation. Study design Prospective observational study. Materials and methods About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience. Statistical analysis used Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test. Results The incidence of difficult intubation determined by the IDS (≥5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of ≥5 gives high false positive for our population. How to cite this article Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.

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Awake insertion of the air-Q intubating laryngeal airway device that facilitates safer tracheal intubation in morbidly obese patients

British Journal of Anaesthesia ◽

10.1093/bja/el_10590 ◽

2013 ◽

Vol 111 (eLetters) ◽

Author(s):

Toshie Shiriaishi

Keyword(s):

Tracheal Intubation ◽

Airway Device ◽

Morbidly Obese ◽

Obese Patients ◽

Laryngeal Airway

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Intubating Laryngeal Mask Airway in Morbidly Obese and Lean Patients

Anesthesiology ◽

10.1097/00000542-200506000-00008 ◽

2005 ◽

Vol 102 (6) ◽

pp. 1106-1109 ◽

Cited By ~ 63

Author(s):

Xavier Combes ◽

Stéphane Sauvat ◽

Bertrand Leroux ◽

Marc Dumerat ◽

Emanuel Sherrer ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Airway Management ◽

Airway Device ◽

Laryngeal Mask ◽

Morbidly Obese ◽

Obese Patients ◽

Healthy Weight ◽

Management Quality ◽

Intubating Laryngeal Mask Airway

Background The intubating laryngeal mask airway (ILMA) was designed using the characteristics of healthy-weight subjects but was shown to be an effective airway device in morbidly obese patients. The authors compared airway management quality in morbidly obese and lean patients with use of the ILMA. Methods Fifty morbidly obese and 50 lean patients (mean body mass indexes, 42 and 27 kg/m, respectively) were enrolled in this prospective study. After induction of general anesthesia, characteristics of airway management were judged on safety and efficiency parameters, including success rate at ventilation and intubation and airway management quality criteria, such as the number of patients who required adjustment maneuvers, the number of failed tracheal intubation attempts, the total duration of airway management, and an overall difficulty visual analog scale score. Results The ILMA was successfully inserted and adequate ventilation through the ILMA was achieved in all 100 patients. The success rates of tracheal intubation through the ILMA were similar in obese and lean patients (96% and 94%, respectively). The numbers of failed blind tracheal access attempts and patients who required airway-adjustment maneuvers were significantly reduced in obese patients as compared with lean patients. Four obese patients experienced transient episodes of oxygen desaturation (oxygen saturation < 90%) before adequate bag ventilation was established with the ILMA. Conclusion The authors confirmed that the ILMA was an efficient airway device for airway management of both lean and obese patients. In the conditions of this study, the authors observed that airway management with the ILMA was simpler in obese patients as compared with lean patients.

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