Morbid Obesity and Tracheal Intubation

Brodsky, Jay B.; Lemmens, Harry J. M.; Brock‐Utne, John G.; Vierra, Mark A.; Saidman, Lawrence J.

doi:10.1097/00000539-200203000-00047

Cited by 574 publications

(394 citation statements)

References 13 publications

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“…Even if the need for awake intubation had been diminished by more frequent use of VL, it is also conceivable that such a decrease could have been masked by a concomitant rise in awake intubation for an increasing population of obese patients 10 in whom a higher incidence of anticipated difficult airway management might be expected. [11][12][13][14][15][16][17][18][19][20] While the overall incidence of awake tracheal intubation was 1.06% of GETA cases, there was substantial variability in the rate (0-3.4 per 100 GETA cases) at which individual attending staff performed the procedure. These results were not controlled for subspecialty practice (e.g., anesthesiologists performing mainly regional vs neuroanesthesia), although anecdotally, the four individuals with the two lowest and the two highest rates of awake intubation had similar practice profiles (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study Incidence, taux de réussite et complications de l'intubation trachéale chez 1554 patients éveillés sur une période de 12 ans: une étude de cohorte historique AbstractPurpose Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) at our institution. Methods The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling. Results Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4 -4 incidenceÁyear -1 ; 95% confidence interval [CI]: -3.0 -4 to 3.0 -5 ; P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidenceÁyear -1 ; 95% CI: 0.076 to 0.083; P \ 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011)(2012)(2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. Conclusions At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway. RésuméObjectif L'intubation trachéale du patient éveillé, qu'on appelle aussi intubation vigile, est une alternative recommandée dans certaines situations précises pour

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Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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“…A large neck circumference is a useful additional indicator and when greater than 60 cm, is associated with a 35% probability of difficult laryngoscopy 51.…”

Section: Pre‐operative Preparationmentioning

confidence: 99%

Peri-operative management of the obese surgical patient 2015

Nightingale¹,

Margarson²,

Shearer³

et al. 2015

Anaesthesia

239

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“…There is agreement, however, that a combination of features, such as Mallampati score C 3 and larger neck circumference, in the obese patient does increase the risk of difficult laryngoscopy and difficult tracheal intubation. 24,25 …”

Section: Direct Laryngoscopy and Intubationmentioning

confidence: 99%

“…Toutefois, les spécialistes s'entendent pour dire qu'une combinaison de plusieurs éléments, tels un score de Mallampati C 3 et une circonférence plus importante du cou chez le patient obèse, augmente le risque de laryngoscopie difficile et d'intubation trachéale difficile. 24,25 L'accès chirurgical aux voies aériennes Dans les situations où il est « impossible d'intuber, impossible de ventiler », une cricothyroïdotomie peut être particulièrement difficile à réaliser chez un patient obèse en Airway management and oxygenation in obese patients 939 raison de la difficulté à identifier les repères anatomiques usuels. Aslani et coll.…”

Section: La Ventilation Au Masqueunclassified