TY - JOUR
T1 - Predictors of a difficult intubation in the bariatric patient
T2 - Does preoperative body mass index matter?
AU - Sheff, Sean R.
AU - May, Maggie C.
AU - Carlisle, Stephen E.
AU - Kallies, Kara J.
AU - Mathiason, Michelle A.
PY - 2013/5/1
Y1 - 2013/5/1
N2 - Background: The incidence of difficult intubations in morbidly obese patients has been reported to be 12-20%; however, no well-established predictors of a difficult intubation exist for this patient population. Our objective was to evaluate the factors associated with a difficult intubation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass at an integrated multispecialty health system with a 325-bed community teaching hospital serving 19 counties. Methods: The anesthetic records of patients undergoing LRYGB from 2001 to 2010 were reviewed. Difficult intubations were defined as direct laryngoscopy graded ≥1 on a 0-2 difficulty scale and unplanned fiberoptic intubations. Statistical analysis included chi-square, univariate, and multivariate logistic regression. Results: A total of 915 consecutive patients underwent LRYGB during the study period. Of these, 3 patients were excluded because of incomplete data. Of the 912 included patients, 25 (2.7%) underwent planned fiberoptic intubation, 830 (91%) had an uneventful intubation, and 57 (6.3%) had a difficult intubation. Difficult intubations were more common in men than in women (11% versus 6%, P =.027). Difficult intubations were not associated with an increasing preoperative body mass index (P =.073), the presence of obstructive sleep apnea (P =.784), or the presence of gastroesophageal reflux disease (P =.335). Multivariate predictors of a difficult intubation were Mallampati class 4 (odds ratio [OR] 2.76, P =.035), abnormal thyromental distance (OR 4.39, P =.001), restricted jaw mobility (OR 3.26, P =.018), and a history of a difficult intubation (OR 4.17, P =.002). Conclusions: An increased Mallampati class, abnormal thyromental distance, restricted jaw mobility, and a history of difficult intubations were independent predictors of a difficult intubation. An increasing body mass index did not predict for a difficult intubation.
AB - Background: The incidence of difficult intubations in morbidly obese patients has been reported to be 12-20%; however, no well-established predictors of a difficult intubation exist for this patient population. Our objective was to evaluate the factors associated with a difficult intubation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass at an integrated multispecialty health system with a 325-bed community teaching hospital serving 19 counties. Methods: The anesthetic records of patients undergoing LRYGB from 2001 to 2010 were reviewed. Difficult intubations were defined as direct laryngoscopy graded ≥1 on a 0-2 difficulty scale and unplanned fiberoptic intubations. Statistical analysis included chi-square, univariate, and multivariate logistic regression. Results: A total of 915 consecutive patients underwent LRYGB during the study period. Of these, 3 patients were excluded because of incomplete data. Of the 912 included patients, 25 (2.7%) underwent planned fiberoptic intubation, 830 (91%) had an uneventful intubation, and 57 (6.3%) had a difficult intubation. Difficult intubations were more common in men than in women (11% versus 6%, P =.027). Difficult intubations were not associated with an increasing preoperative body mass index (P =.073), the presence of obstructive sleep apnea (P =.784), or the presence of gastroesophageal reflux disease (P =.335). Multivariate predictors of a difficult intubation were Mallampati class 4 (odds ratio [OR] 2.76, P =.035), abnormal thyromental distance (OR 4.39, P =.001), restricted jaw mobility (OR 3.26, P =.018), and a history of a difficult intubation (OR 4.17, P =.002). Conclusions: An increased Mallampati class, abnormal thyromental distance, restricted jaw mobility, and a history of difficult intubations were independent predictors of a difficult intubation. An increasing body mass index did not predict for a difficult intubation.
KW - Airway management
KW - Anesthesia
KW - Complications
KW - Difficult laryngoscopy
KW - Fiberoptic intubation
KW - Laparoscopic gastric bypass
KW - Morbid obesity
KW - Preoperative characteristics
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U2 - 10.1016/j.soard.2012.02.004
DO - 10.1016/j.soard.2012.02.004
M3 - Article
C2 - 22475762
AN - SCOPUS:84878549442
SN - 1550-7289
VL - 9
SP - 344
EP - 349
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 3
ER -