Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units

Jong, Audrey De; Molinari, Nicolas; Pouzeratte, Y.; Verzilli, Daniel; Chanques, Gérald; Jung, Boris; Futier, Emmanuel; Pérrigault, Pierre-François; Colson, P; Capdevila, Xavier; Jaber, Samir

doi:10.1093/bja/aeu373

Cited by 200 publications

(142 citation statements)

References 42 publications

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“…The risk of intubation difficulty is two-fold higher in the obese patients [4]. Fat deposition around the neck and large tongue in obese patients complicate laryngoscopic view and intubation [5].…”

Section: Discussionmentioning

confidence: 99%

Upper airway injury caused by gum elastic bougie

Özcan¹,

Balci²,

Aksoy³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes ABSTRACTIntroduction: Difficulties and complications associated with intubation are among the leading causes of surgery-related mortality in patients with obesity and obstructive sleep apnea. It is known that during perioperative intubations, the progression of the bougie may lead to serious injury and even rupturing in the trachea. Case Report: A 46-year-old ASA II patient was assessed preoperatively for uvuloplasty. His body mass index was 34.7. Preparation was completed for the difficult intubation. The patient could not directly intubated with laryngoscopy but was intubated with bougie in the second trial. After the surgery 200 mg bridion was administered and the patient was extubated. He was then followed-up in PACU. Due to the stridor, it was thought that there was edema in his upper airway. At 45 minutes of PACU follow-up, it was noticed that upper airway edema regressed but there was subcutaneous emphysema giving a sense of rattle during palpation in the periphery of the right eye. It spread rapidly over the face. Afterwards he was intubated again through video laryngoscopy due to the risk of upper airway obstruction. Fiber optic examination and thorax tomography revealed that the fistula line was on the left lateral wall following cricoid cartilage. Mucosal damage of the patient healed spontaneously and weaning was conducted three days later in the ICU. Conclusion: It was reported that tracheal injury and rupture occurs due to 'blind' advancement of the bougie during intubation. Due to the identification of subcutaneous emphysema at 45 minutes during follow-up, it was thought that the bougie caused injury in the patient. The close long-term postoperative follow-up is important in cases where difficult intubation is conducted with bougie and intubation is achieved through multiple trials.

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Section: Discussionmentioning

confidence: 99%

Upper airway injury caused by gum elastic bougie

Özcan¹,

Balci²,

Aksoy³

et al. 2017

IJCRI

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“…Patient files and electronic hospital database were evaluated to identify patient demographic aspects and comorbid conditions ( , absence of teeth, limited mouth opening (<3 cm), limited neck movement and short neck, presence of dentures, and presence of obstructive sleep apnea (OSA) 3,7 was collected from the routine standard form filled in by the anesthesiologists during preoperative visit and during induction of anesthesia. As our standard records also include reliable information concerning induction of anesthesia and mask ventilation difficulty rated by staff anesthesiologist in a standardized manner, we were able to classify patients into three separate groups with respect to difficulty in airway management as follows: DMV (Han's mask ventilation classification grade 3 or 4 mask ventilation) 10 ; DL (grade 3 or 4 laryngoscopic view or ≥4 intubation attempts) 11 ; and DMV combined with DL.…”

Section: Methodsmentioning

confidence: 99%

“…So, the anesthetic management of those patients may remain challenging. While there are many reports comparing the anesthetic complications between obese and lean patients [3][4][5][6][7][8] , there is no report whether further increase in BMI has additional implication, and which bedside screening test is more meaningful for predicting DMV and DL when only obese group is considered. The aim of this study was to evaluate DMV and DL in this unique group of adult obese patients with endometrial cancer.…”

Section: Introductionmentioning

confidence: 99%

Evaluation and Management of Difficult Airway in Obesity: A Single Center Retrospective Study

Ayhan

Kaplan

Kayhan

et al. 2016

ACC

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SUMMARY -The primary aim of this single center retrospective study was to evaluate difficult mask ventilation (DMV) and difficult laryngoscopy (DL) in a unique group of obese patients. A total of 427 adult patients with body mass index (BMI) ≥25 and surgically treated for endometrial cancer from 2011 to 2014 were assessed. Additional increase in BMI, comorbidities, bedside screening tests for risk factors, and the tools used to manage the patients were noted and their effects on DMV and/or DL investigated. Every escalation in the number of risk factors increased the probability of DMV 2.2-fold, DL 1.8-fold and DMV+DL 3.0-fold. Among bedside tests, limited neck movement (LNM), short neck (SN) and absence of teeth were significant for DMV (p<0.05), LNM, SN and obstructive sleep apnea for DL (p<0.05), and LNM and SN for DMV+DL (p<0.05). However, a 10-point increase of BMI was not an independent risk factor when patients with BMI >25% were considered. In conclusion, LNM and SN are independent risk factors for developing DMV and/or DL in obese endometrial cancer patients, while BMI increase over 30 was not additionally affecting difficult airway.

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“…In the same way, tracheal intubation is more difficult in obese patients with obstructive apnea syndrome, with an incidence close to 15 to 20% (versus 2 to 5% in the general population), and associated with the severity of the obstructive apnea syndrome [26]. A recent study reported an increase in the incidence of difficult intubation in obese patients [3]. Moreover, in this study, elevated Mallampati score, limited mouth opening, reduced cervical mobility, presence of an obstructive apnea syndrome, coma and severe hypoxemia (risk factors included in the MACOCHA score [27]) were associated with difficult intubation in obese patients.…”

Section: Intubationmentioning

confidence: 98%