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Predictors of difficult intubation in obesity rates – The influence of morbid obesity on difficult intubation and difficult mask ventilation

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William Murphy
Tuesday, December 11, 2018
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  • We used a full logistic regression model with all the aforementioned risk factors and other confounders fitted. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units A.

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  • We believe that a dedicated and committed team of editors and reviewers make it possible to ensure the quality of the research papers. Lemmens, Jay B.

Background

Neck circumference of 43 cm or greater was classified as predicting a difficult intubation. Table 1 Characteristics of eligible trials Full size table. Tiffany S.

Open in new tab Download slide. Part 1: anaesthesia. Moreover, the use of difficklt difficult airway management techniques was markedly less in the ICU compared with OT. Before anaesthesia, the anaesthetist should be able to answer key questions. UPSI was later upgraded to a full university institution on 1 May,an upgrade from their previous college status. The articles are among the best and cover most scientific areas.

ALSO READ: Nice Guidelines Obesity Quick Reference Sheet

The authors report a significantly greater usage of airway adjuncts and definitive techniques in the OT than in the ICU. Peer-review of articles for the journal, which are in the area of expertise 2 to 3 times per year. Fig 4 online video Normal nasendoscopy. Dear Editor: We read with great interest the work of De Jong and colleagues [1] relating to difficult intubation in the obese patients in the intensive care unit ICU and operating theatre OT and congratulate the authors on the scope of their study. Anaesth Intensive Care ; 30 : — 6. Anesthesiology Featured Articles Alert. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups.

Mouth opening ability is obseity to most airway interventions and is best measured as an inter-incisor gap. However, in patients with neck mass a single factor can be significant predictor of difficult intubation [ 8 ]. As with any patient, the anesthesiologist must always be prepared to manage airway problems. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals.

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Results Indirect mirror laryngoscopy was attempted in all 60 patients; however, 8 The summary ROC infubation showed a trend toward variation predictors of difficult intubation in obesity rates overall diagnostic performance of the thyromental test in relation to test threshold. After obtaining the approval of the Institutional Review Board, a computerized search was initiated through the electronic medical records, which revealed 20, patients who underwent abdominal surgery requiring general anesthesia at The Ohio State University Wexner Medical Center during a period of 12 months, from January 1, to December 31, Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue.

  • Anesthesiology 2 —

  • Results: Of 45, analyzed cases, 4.

  • Capdevila, S. The result is the pooled estimate of the 12 included studies by random effect model.

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However we also feel that there are some issues relating to the study worthy of further debate. In addition, in this study, risk factors for difficult intubation in OT were similar to those found in the literature for obese patients, that is, Mallampati score, 3536 and obstructive sleep apnoea syndrome. It's obvious that patients who are intubated in OT under controlled conditions with several gadgets available at the disposal of anaesthesiologist have more success rate than the patients who are intubated in ICU, provided they are intubated electively. Three-dimensional 3D images and use of post-reconstruction processing software e. The basis of the Mallampati evaluation is to judge the size of the tongue in relation to the oral cavity as the tongue must be displaced for adequate laryngoscopic view. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor.

Laryngeal tumours, vocal cord palsies, and subglottic rwtes will impact on technique and equipment choice, particularly in relation to tracheal tube sizing or suitability for awake fibreoscopy. The incidence is not quite small that anesthetists should use necessary tests to predict the difficult intubation. These assess multiple predictors, with summed or weighted scores, with increased PPVs compared with single tests in isolation. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community. These free-to-view online journals cover all major disciplines of science, medicine, technology and social sciences.

References

Background: As obesity rates continue to rise in diffjcult United States, the question of whether morbidly obese patients are more difficult to intubate is a growing concern. Classical predictors of difficult laryngoscopy and intubation have been shown to be unreliable. A systematic review was conducted to assess the association between obesity and difficult intubation.

The abnormal findings should be highlighted and should be given predictors of difficult intubation in obesity rates hand over to colleagues during shift change in borderline patients who may require intubation so that necessary arrangements is made and a senior colleague's help is sought if required. Introduction: Difficult tracheal intubation is a common source of mortality and morbidity in surgical and critical care settings. The extended Mallampati score and a diagnosis of diabetes mellitus are predictors of difficult laryngoscopy in the morbidly obese. Open in a separate window.

To assess the potential for publication bias, a funnel plot was constructed in which the log of relative risks was plotted against the associated number of patients. Google Scholar Crossref. The underweight patients constituted a much smaller group compared to the other groups, making it impossible to obtain conclusive results. However, difficult tracheal intubation has many influencing factors. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management.

  • Morbid obesity and tracheal intubation. We performed a retrospective chart review of patients who underwent abdominal surgeries with ASA stratification I—V under general anesthesia requiring endotracheal intubation.

  • The articles published in the open access journals are high quality and cover a wide range of fields.

  • E-mail: s-jaber chu-montpellier.

  • We used a full logistic regression model with all the aforementioned risk factors and other confounders fitted. The general characteristics of the published articles included in this meta-analysis are shown in Table 1.

Difficult intubation was determined by the intubation difficulty scale IDSa validated 7-item questionnaire administered to anesthesia providers to be completed after intubation. After reviewing the full texts, 16 studies published between and were selected for inclusion. We sequentially removed each study and those that included emergency tracheal intubation or parturients and then reanalysed the remaining dataset. This wide variation in incidence is due to the discrepancy in the definition of difficult mask ventilation and these definitions are subjective and observer dependent. Moon, T. The following information was obtained from medical records for analysis: gender, age, height, weight, BMI, length of patient stay in the Post Anesthesia Care Unit PACUpast medical history of sleep apnea, Mallampati score, and the ASA classification assigned by the anesthesia.

Data from obese patients intubated in ICU have intuvation presented in part in a previously published study. There was no difference regarding grading of laryngoscopy between the two groups. Anesth Analg. Conclusion Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. It is another argument to introduce the expertise acquired in OT in ICU, to further reduce the life-threatening complications associated with intubation.

MeSH terms

A multivariate model was constructed using the intubations of obese patients in the OT where all data were available. As the outcome of the study was rare among all populations, ORs and HRs were directly considered as RRs in this study [ 18 ]. In addition, the Mallampati score was assessed in recumbent patients in the ICU cohort.

Finally, Dr Nair mentioned that the Modified Mallampati Score performed in supine position is not reliable to preidctors difficulty of intubation. MRI is useful for soft tissue pathology, but the ability of many patients to lie flat for prolonged periods can be limiting. During routine preoperative assessment of patients one of the commonest practices is predicting difficulty of tracheal intubation from various factors detected. Chanques, B. Neck circumference 35 and neck circumference to thyromental distance 36 were not available in our OT database, even if defined as risk factors of difficult intubation in obese patients in previous studies. Proposals have also been made for its use in predicting difficult intubation by measurement of various parameters, including tongue thickness, pre-tracheal fat at vocal cord level Fig.

Greenland S. Ann Fr Anesth Reanim ; —5. The ontubation of difficult tracheal intubation and preoperative assessments in different age groups. Therefore, the discriminative power is greater when the tests are used in combination rather than alone. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Table 3 Subgroup analysis of the outcomes Full size table.

Publication types

No unpublished study in clinicaltrial. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anaesthesia 63 12 —

We agree with Dr Glossop, Esquinas and Nair when they accurately noticed that most of intubations were performed "out of hours" and intuation extreme emergency, often by non expert operators. All rights reserved. Close Modal. Part 1: anaesthesia. Furthermore there is substance to the theory that intubation in the OT is more controlled than in the ICU [3], and this may also contribute to the overall reduction in complications and difficulties with intubation in obese theatre patients. Risk of severe life-threatening complications in obese patients according to the ease of intubation and location. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd.

Conflict of Interest: Difficukt declared. Google Scholar. Predictors of difficult intubation in obesity rates, the research articles span a wide range of area and of high quality. Bentham Open ensures speedy peer review process and accepted papers are published within 2 weeks of final acceptance. Neck circumference 35 and neck circumference to thyromental distance 36 were not available in our OT database, even if defined as risk factors of difficult intubation in obese patients in previous studies. Centre Antipoison-Centre de Pharmacovigilance, France.

INTRODUCTION

Br J Anaesth 53 8 —6. We used a full logistic regression model with all the aforementioned risk factors and other confounders fitted. Lavi et al.

  • Age yr 64 18—95 62 18—79 64 19—95 0. Disclosures: Y.

  • Glossop with Antonio M.

  • Anaesth Intensive Care ; — Yentis SM.

  • A clinical sign to predict difficult tracheal intubation: a prospective study.

  • Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia.

  • Google Scholar PubMed. This could be one of the reason why difficulty is encountered in intubating such patients 2.

Modified Mallampati class 3 or 4 is predominant in those with DL due to an imbalance in the tongue and oral cavity relationship. Ratio of patients height to thyromental distance improves prediction of difficult laryngoscopy. Harry J. Ultrasound use for the detection pedictors large midline vasculature in assessing suitability for percutaneous tracheostomy is well established and its use as an aid for both identification of the cricothyroid membrane Fig. The authors note that intubation within the ICU setting is an independent risk factor for severe complications compared to the OT, and that patients within the ICU tend to have less physiological reserve and higher prevalence of organ failures prior to intubation. Peer-review of articles for the journal, which are in the area of expertise 2 to 3 times per year.

Maximum mouth prrdictors also determines the easiness of airway management and endotracheal intubation. De JongA. The ease of laryngoscopy is significantly affected by mandibular mobility, and the ULBT is a measure of this. Out of patients; 20 underwent orthopedic surgeries, 18 gynecologic surgeries and 82 general surgeries. Simple bed side patient evaluation can minimize anesthesia related airway morbidity and mortality.

ORIGINAL RESEARCH article

Part 1: anaesthesia. TMHT is a measure of vertical height from the anterior border of the thyroid cartilage and the anterior border of the mentum. Recent acute respiratory tract infections can increase the possibility of laryngospasm and bronchospasm. Large neck circumference, increased pre-tracheal soft tissue, and occipital tissue are associated with difficulty, the latter impacting on achieving optimal positioning through limitation of neck extension.

Combination of more than two parameters predicts expected difficulty intubatiln than using single factor. In both cohorts, the Mallampati score, previous documented difficult intubation, limited mouth opening, reduced mobility of cervical spine, and obstructive sleep apnoea syndrome were associated with difficult intubation in univariate analysis. Anaesthesia ; 63 : — Maximum mouth opening also determines the easiness of airway management and endotracheal intubation.

  • We also thank Toshiro Shitara, M.

  • Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients.

  • Within the eligible patients group, a total of Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients.

  • Suboptimal positioning would result in a higher incidence of grade 3 and 4 Cormack-Lehane laryngoscopy views, making direct laryngoscopy and hence tracheal intubation more challenging.

  • However, hypoxemia and cardiovascular collapse were considered as complications only if there were not present before intubation. However emergency intubation in ICU is contemplated when there's a cardiac arrest, sudden deterioration of GCS requiring airway protection or sudden cardiovascular compromise massive bleed, left ventricular failure leading to pulmonary oedema.

  • All nine patients with ULBT-3 had easy intubation. Life-threatening complications of intubation were associated with both ICU admission and difficult intubation in the obese patient.

Table 1 Wilson risk sum score 2. Results Of 45, analyzed cases, 4. Extensive research on fat distribution has been conducted in the field of sleep apnea, and those results may prove to be beneficial to research involving surgical airway management. In: Miller RD, editor.

Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations. The Intubation Difficult intubation Scale IDS score, an objective scoring ohesity that consists of numerical expressions of parameters and has been validated in many studies, was proposed to assess intubation difficulty in a standardized manner [ 13 ]. However, subgroup analysis showed no significant association of obesity with DI risk compared with non-obesity in cohort studies. Br J Anaesth. Difficult tracheal intubation: A retrospective study.

Application Error

Combination of more than two parameters predicts expected difficulty better than using single factor. These factors will impact on the ability to displace tissue into the prsdictors space and impede anterior movement of structures during laryngoscopy, all of which will influence the degree of glottic visualization. Based on both our clinical experience at an active bariatric surgical center and on the few prospective studies that have addressed this issue, we question the validity of the general statement that obese patients are three times more difficult to intubate than their slimmer counterparts. The secondary endpoint was to compare risk factors for difficult intubation, difficult airway management techniques, and severe life-threatening complications related to intubation in obese patients admitted to ICU and OT. UPSI was later upgraded to a full university institution on 1 May,an upgrade from their previous college status.

These results could be explained difficutl the failure to recognize the problem of airway management in ICU, the lack of skills, 6 or the lack of equipment. A narrow or high arching palate will also reduce space for the blade in the oropharynx. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units A. As with any patient, the anesthesiologist must always be prepared to manage airway problems.

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Timing of intubation in the ICU and level of expertise of operator may also preditors contributed to the large increase in difficulties and complications reported in obese ICU patients compared to OT patients. Table 3. Accepted : 20 November We feel in supine position, the MPS will give information about mouth opening only which correlates poorly with laryngoscopy. We also thank Toshiro Shitara, M.

In predicting DA, the actual diifficult of body fat should be considered, with fat deposition in the parapharyngeal tissues increasing airway collapsibility, predisposing to OSA. Clinical investigations. All authors read and approved the final manuscript. Overall, this study provides more compelling evidence that airway intervention on ICU has its own inherent dangers that need to be addressed in order to improve patient safety. Maximum mouth opening also determines the easiness of airway management and endotracheal intubation.

Clinical examination

Anesth Analg ; —8. For instance, Shiga et al. ICU cohort. Glossop with Antonio M.

Additionally, there is further evidence of difficuly differences between the two groups of patients in the method of intubation utilised. Secondary endpoints were the risk factors predictors of difficult intubation in obesity rates difficult intubation, the use of difficult airway management techniques, and severe life-threatening complications related to intubation death, cardiac arrest, severe hypoxaemia, severe cardiovascular collapse. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome OSAS and anatomical parameters. Open access journals offer a good alternative for free access to good quality scientific information. The flow chart of the study is shown in Figure 1. Molinari, Y. Practice guidelines for management of the difficult airway; an updated report by the American Society of Anaesthesiologists Task Force on Management of the Difficult Airway.

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Ijtubation J Anaesth. Therefore, it does not seem likely that it is "just a manifestation of the worsening pathophysiology already frequently present". Anesthesia care providers are currently using numerous scoring tools, systems, and methods designed to predict potential difficult tracheal intubation. Article PubMed Google Scholar 5. In case of emergency intubation in ICU out of hours, the physician will have no help available.

  • The regression coefficient b examines the extent to which the log odds ratio is dependent on the threshold values chosen. Incidence and predictors of difficult and impossible mask ventilation.

  • Life-threatening complications of intubation were associated with both ICU admission and difficult intubation in the obese patient. Of all difficult intubations encountered, none of them had failed intubation.

  • The authors indentified patients presenting on the day of surgery in the pre-operative holding area. Should any predictive attempt be advocated?

  • View Editorial Board.

  • When compared to the lean cohort, the morbidly obese group had an increased incidence of moderately difficult intubation Table 2.

These intubaton online journals cover all major disciplines of science, medicine, technology and social sciences. The overall standing of a journal is in a way, reflective of the quality of its Editor s and Editorial Board and its members. If reading the pdf online, click on the image to view the video. The flow chart of the study is shown in Figure 1.

While not strictly part of the clinical history, the obdsity must also be considered, as the incidence of DA is increased up to fold in emergency departments and intensive care units. Jung, E. Cite Cite A. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation? De Jong.

RESEARCH ARTICLE

As in the case of previous authors, there were significantly more female patients included in the study group compared to males. About this article. A view of grade was classified as predicting difficult intubation. Airway management in obese patients. Metrics details.

None of these tests are predivtors indicator of difficult intubation [ 7 ]. Abstract Background and objectives: Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Table 2 presents specific variables recorded in the ICU cohort according to difficult intubation in obese patients. Particular attention should be paid in obese patients, who are at increased risk of postoperative airway complications and desaturation, along with those patients undergoing airway surgery, head and neck surgery, and those maintained in Trendelenburg or prone positions or with prolonged intubation. Close mobile search navigation Article Navigation.

To control the Type I error rate for multiple hypothesis testing, we used the Bonferroni correction as follows:. Correspondence to Tiffany S. Chapter Google Scholar J Clin Anesth 21 4 —7.

To the Editor:—

Primary and secondary outcomes The primary outcome was rate of difficult intibation intubation. If a definition seemed so subjective as to be generally unacceptable, we abandoned it and substituted the Cormack—Lehane grades whenever available. Reynolds SF, Heffner J. Difficult intubation and ICU setting were associated with severe life-threatening complications. Zvara 2Erika G.

Issue Section:. Extubation remains an important part of an airway strategy, and this should be considered both before operation and again intraoperatively to ensure the original plan remains suitable. The Size of the Problem. Search Menu.

One of the limits of the study is the bias jntubation by the different time said obsessive during which data was prospectively collected. Email alerts Article Activity Alert. This could be explained by the large use of video laryngoscopes in our four OT centres in the case of difficult intubation. A reduction in space within the oropharynx may not allow easy tracheal tube manipulation. The importance of increased neck circumference to intubation difficulties in obese patients. Anesthesiology ; — Mask ventilation is the most basic, and arguably most important, skill in airway management.

References

Intubation is associated with life-threatening complications both in intensive care unit ICU 1—6 and in operating theatres OTs. For Permissions, please email: journals. Connect with Us.

The number of intubated patients screened was in the ICU cohort, admitted predictors of difficult intubation in obesity rates September to Apriland 11 in the OT cohort, admitted from January to December All four of the studies they analyzed specifically stated that the magnitude of obesity does not influence laryngoscopy difficulty. He has nearly 40 years of experience in biochemical research focusing on Neurosciences and Pain. These can be considered as limitation. In this study, we wanted to focus on airway management in obese patients, and on the differences between ICU and OT. This evaluation has been found to be fairly specific without great sensitivity.

Therefore, the discriminative power is greater when the tests are used in combination rather than alone. Br J Anaesth. Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91, consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database.

These assess multiple predictors, with summed or weighted scores, with increased PPVs compared with single tests in isolation. Tracheal rates in the critically ill: a multi-centre national study of practice and complications. Computed divficult and MRI scans have improved the assessment of patients with complex airway pathology, although some anaesthetists may not feel comfortable with their interpretation. We present the results of a prospective study where the incidence of difficult intubation, the risk factors of difficult intubation, the difficult airway management techniques, and the complications related to intubation were compared between two cohorts of obese patients admitted to ICU and OT and undergoing intubation.

Introduction

Nonetheless, high heterogeneity among the studies included in this analysis limits the intubatikn of our findings. Obese group had a higher incidence of difficult mask ventilation and greater IDS score however, there was no difference in difficult laryngoscopy. Methods: A cohort of 2, patients were recruited at a large, tertiary, public hospital in a month period.

Predicting difficult airways using the intubation difficulty scale: a study comparing obese and non-obese patients. Masui ; — Background: As obesity rates continue to rise in the Difficult intubation States, the question of whether morbidly obese patients are more difficult to intubate is a rahes concern. Middle East J Anesthesiol ; — As suggested by Alex Czech, to assess the effect of obesity on the incidence of difficult intubation in both operating theatre OT and Intensive Care Unit ICUwe have calculated the incidence of difficult intubation in the non-obese population during the study period. To assess the potential for publication bias, a funnel plot was constructed in which the log of relative risks was plotted against the associated number of patients. Table 3 Relationship between methodology and laryngoscopic view by wilcoxon ranks sum test Chi 2 approximation.

A complete obesity rates of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient intubayion the same position with airway equipment used for intubation. Predicting difficulty in laryngoscopy. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. Abstract Background: During routine preoperative assessment of patients one of the commonest practices is predicting difficulty of tracheal intubation from various factors detected. Obes Surg ;—5.

Enterlein G, Byhahn C. Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool. Zvara 2Erika G. However, no strong predictors of difficult intubation have been established for the obese and morbidly obese populations.

It is this facet of management that should influence our decision-making the most, predicyors with consideration given to awake techniques. This should take into account anatomical variations, airway pathology, and previous strategies. There is no ideal airway assessment tool that can be used, and the lack of statistical predictive power of individual airway tests is well accepted. Ren Dr. This finding is almost in line with findings in a study on Kashmir population.

Several studies based on multivariate analysis 3,51 indicated that limited mouth opening is strongly associated with difficult intubation. Moon, M. Data for obstetric population, however, remain inconclusive because of the small number of studies and the heterogeneity. Extensive research on fat distribution has been conducted in the field of sleep apnea, and those results may prove to be beneficial to research involving surgical airway management.

In obese patients, difficult intubation incidence was twice higher in ICU than in the OT, while severe life-threatening complications related to intubation occurred 20 times more often in ICU than in the Difficult intubation. Anesthesiology ; 98 : — There is nothing to suggest that RSI is a risk factor for difficult intubation or increased complications of intubation [2], but this very large disparity once again highlights the substantial differences in patient demographics between the two groups. Accordingly, further studies are required to determine if a better management of intubation in ICU could reduce the incidence of difficult intubation and severe life-threatening complications related to intubation in obese patients. Peer Review Workflow Reviewers Guidelines. If you are interested in becoming our Editorial Board member, please submit the following information to info benthamopen.

Clinical history

This test is good indicator of difficult intubation in our study. Correspondence March Online videos. RESULT consecutive adult patients scheduled for elective surgery under general anesthesia with endotracheal intubation were selected and of them fulfilled the inclusion criteria and employed in this study. Article Contents Abstract.

We acknowledge that the aforementioned examinations are overwhelming and excessive for most patients. Perrigault, P. Survey predictors of difficult intubation in obesity rates airway management strategies and experience of non-consultant doctors in ontubation care units in the UK. As accurately stated by Dr Glossop and Esquinas, hypoxemia and cardiovascular collapse were the two most common severe complications seen post intubation in obese ICU patients. Peer-review of articles for the journal, which are in the area of expertise 2 to 3 times per year. Abstract Purpose: To determine the influence of morbid obesity on the incidence of difficult mask ventilation and difficult intubation.

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Savva D: Prediction of difficult tracheal intubation. Despite the small group sizes in the study, their results may constitute a possible explanation of our findings of sex-related difference ditficult the BMI predictive value. In obese patients, difficult intubation incidence was twice higher in ICU than in the OT, while severe life-threatening complications related to intubation occurred 20 times more often in ICU than in the OT. Can Anaesth Soc J ; — Cite this article Wang, T. Somasundaram: None. Screening tests included the Mallampati oropharyngeal classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score.

The limitations of the present study are that we were unable to do randomized controlled trial because the observer could not be blinded to do airway examination or intubation as obesity cannot be concealed. Table 2 Intubation difficulty scale. Philadelphia: Churchill Livingstone,pp — Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia. Date and time of intubation were not recorded in the OT cohort.

Twelve intubaation with a total of patients were analysed [ 71423242628293031323334 ]. Sensitivity predictors of difficult intubation in obesity rates the ratio of the true-positive number to the sum of true-positive plus false-negative numbers. We present the results of a prospective study where the incidence of difficult intubation, the risk factors of difficult intubation, the difficult airway management techniques, and the complications related to intubation were compared between two cohorts of obese patients admitted to ICU and OT and undergoing intubation. Figure 2. Koenig S. Relationship between difficult tracheal intubation and obstructive sleep apnoea. However, only three studies were included in our analysis.

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