Neck circumference as a predictor of difficult intubation and difficult mask ventilation 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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Cleft Lip and Palate Surgery: Prevalance of Intraoperative Airway Complications in a Tertiary Center in Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27021 ◽

2020 ◽

Vol 4 (3) ◽

pp. 805-808

Author(s):

Ajay Singh Thapa ◽

Rajesh Kumar Yadav

Keyword(s):

Difficult Intubation ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Mask Ventilation ◽

Cross Sectional ◽

Airway Complications ◽

Difficult Mask Ventilation ◽

Tertiary Center

Introduction: Cleft lip and palate is one of the most common congenital malformations. Different syndromes have been described in association with cleft lip and palate, some of which have considerable anesthetic implications, and many involve potential airway problems. Objective: This study aimed to find the incidence of airway complications during cleft surgeries. Methods: The descriptive cross sectional study was conducted in College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal over a period of one year from March 2017 toFebruary2018. All the 146 patients received general anesthesia. The parameters studied were incidence of difficult mask ventilation, difficult intubation, laryngospasm, bronchospasm, aspiration of blood and secretion. Univariate analysis of demographic and occurrence of complications was done. Results: A total of 146 patients underwent cleft surgery over the study duration out of which 42(28.76%) were female and 104(71.23%) were male. Isolated cleft lip was seen in 104 (71.23%) patients among whom 42 (28.76%) had right sided, 50 (34.24%) had left sided and 12 (8.21%) had bilateral cleft lip. Isolated cleft palate was seen in 12 (8.21%) patients. Combined cleft lip and palate was seen in 30 (20.54%) patients. Prevalence of difficult mask ventilation, difficult laryngoscopy, difficult intubation, incidence of bleeding during intubation, bronchospasm and post extubationlaryngospasmwere4 (2.73%), 11 (7.53%), 6 (4.10%), 2 (1.36%), 2(1.36%) and 4(2.73%). Conclusion: In cleft repair surgeries, difficult laryngoscopic view is the most common problem followed by difficult intubation and difficult mask ventilation. Complications like laryngospasm, bronchospasm and laryngoscopy related bleeding are not uncommon. Vigilant perioperative preparation and continuous monitoring is essential to prevent complications during cleft repair surgery in paediatric patients.

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