The influence of morbid obesity on difficult intubation and difficult mask ventilation

Moon, Tiffany S.; Fox, Pamela E.; Somasundaram, Alwin; Minhajuddin, Abu; Gonzales, Michael X.; Pak, Taylor; Ogunnaike, Babatunde

doi:10.1007/s00540-018-2592-7

Cited by 74 publications

(54 citation statements)

References 31 publications

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“…Increased oxygen consumption can lead to respiratory failure and predispose the need for more oxygen support. In addition, due to anatomical factor obese patients have a higher incidence difficult mask ventilation compared to non-obese patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Soeroto

Soetedjo

Purwiga

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

149

128

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Background and aims Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients. Methods We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality. Results Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m 2 ). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67–1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25–2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension. Conclusion Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.

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Section: Discussionmentioning

confidence: 99%

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Soeroto

Soetedjo

Purwiga

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

149

128

View full text Add to dashboard Cite

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“…38 These data suggest that the RAS may be involved in the association between obesity and COVID-19. 86 The facial features of people with obesity may differ from those without, 87,88 and it may be more difficult to find the right mask size for people with obesity.…”

Section: Implication Of Alterations In the Renin-angiotensin System Amentioning

confidence: 99%

Proper Management of People with Obesity during the COVID-19 Pandemic

Lim

Shin

Nam

et al. 2020

JOMES

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, countries around the world have been struggling with a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case series have reported that people with obesity experience more severe coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic, people have tended to gain weight because of environmental factors imposed by quarantine policies, such as decreased physical activity and increased consumption of unhealthy food. Mechanisms have been postulated to explain the association between COVID-19 and obesity. COVID-19 aggravates inflammation and hypoxia in people with obesity, which can lead to severe illness and the need for intensive care. The immune system is compromised in people with obesity and COVID-19 affects the immune system, which can lead to complications. Interleukin-6 and other cytokines play an important role in the progression of COVID-19. The inflammatory response, critical illness, and underlying risk factors may all predispose to complications of obesity such as diabetes mellitus and cardiovascular diseases. The common medications used to treat people with obesity, such as glucagon-like peptide-1 analogues, statins, and antiplatelets agents, should be continued because these agents have anti-inflammatory properties and play protective roles against cardiovascular and all-cause mortality. It is also recommended that renin-angiotensin system blockers are not stopped during the COVID-19 pandemic because no definitive data about the harm or benefits of these agents have been reported. During the COVID-19 pandemic, social activities have been discouraged and exercise facilities have been closed. Under these restrictions, tailored lifestyle modifications such as home exercise training and cooking of healthy food are encouraged.

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“…[ 29 ] SMDR did not seem to correlate with BMI (despite the fact that patients in our study were rather obese, mean BMI: 27.1), also in accordance with the aforementioned study,[ 29 ] and this fact comes to concur with other studies which failed to establish a correlation between BMI and difficult laryngoscopy. [ 15 16 ] The same applies for Mallampati score as previously reported. [ 18 19 20 24 ] In contrast to the study by Prakash et al .,[ 29 ] where the sternomental difference was associated with age, SMDR was not associated with age.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 19 20 24 ] In contrast to the study by Prakash et al .,[ 29 ] where the sternomental difference was associated with age, SMDR was not associated with age. There is evidence[ 16 19 30 ] in the international literature that age may correlate with difficult intubation, but the ethnicity effect cannot be excluded and further data from larger studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Over the years, several predictive scores for difficult airway have been proposed, with the most common being the Mallampati score,[ 7 ] the thyromental distance (TMD),[ 8 9 ] the sternomental distance (SMD),[ 10 ] the upper lip bite test (ULBT)[ 11 ] and cervical spine mobility. [ 12 13 14 ] Other factors such as body mass index (BMI)[ 15 16 ] or protruding incisors[ 17 ] have also been assessed. Despite the fact that they can be relative indicators of a difficult airway, none of them can reliably exclude difficult intubation and none of them has exhibited high sensitivity as a single test, and at most cases not even as when combined with another score.…”

Section: Introductionmentioning

confidence: 99%

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Sternomental distance ratio as a predictor of difficult laryngoscopy: A prospective, double-blind pilot study

et al. 2020

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Background: No single test has shown to be an accurate predictor of difficult laryngoscopy. Aims: This study aims to evaluate the effectiveness of the ratio of the sternomental distance (SMD) in neutral and full neck extension position SMD ratio (SMDR) as a predictor of difficult laryngoscopy and any need of assisted intubation. Settings and Design: Prospective, double-blind pilot study. Materials and Methods: This study included 221 consecutive adult patients scheduled to undergo elective surgery under general anesthesia. Physical and airway characteristics, SMDR, difficult laryngoscopy (using Cormack/Lehane [C/L] scale), and any kind of assisted intubation were assessed. Statistical Analysis: The optimal cutoff point for SMDR was identified using receiver operating characteristic (ROC) analysis. The association between SMDR and the intubation method was evaluated through multiple logistic regression analysis. Results: A SMDR below 1.55 led in 33% of the cases to assisted intubation and 33%–53% of C/L III–IV glottic views for McCoy and Macintosh blades, respectively. On the other hand, SMDR above 1.9 led to no C/L IV glottic views for both blades and 4% and 11% C/L III views glottic views for McCoy and Macintosh, respectively. The best sensitivity and specificity cutoff point as defined by the ROC curve was identified for an SMDR value of 1.7 (area[s] under the curve: 0.815; 95% confidence interval: 0.743–0.887). Assisted intubation rates were significantly higher in patients with an SMDR inferior to 1.7 (30.5% compared to 3.5%, P < 0.001). Conclusions: SMDR is a simple, objective, and easy to perform test. The present study indicates that SMDR may be helpful in predicting difficult laryngoscopy and assisted intubation.

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The influence of morbid obesity on difficult intubation and difficult mask ventilation

Cited by 74 publications

References 31 publications

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis

Proper Management of People with Obesity during the COVID-19 Pandemic

Sternomental distance ratio as a predictor of difficult laryngoscopy: A prospective, double-blind pilot study

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