Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter?

• Published in: Surgery for obesity and related diseases Vol. 9; no. 3; pp. 344 - 349
• Main Authors: Sheff, Sean R., M.D, May, Maggie C., B.S, Carlisle, Stephen E., M.D, Kallies, Kara J., B.A, Mathiason, Michelle A., M.S, Kothari, Shanu N., M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2013
• Subjects: Adult; Airway management; Anesthesia; Body Mass Index; Complications; Difficult laryngoscopy; Female; Fiber Optic Technology; Fiberoptic intubation; Gastric Bypass - methods; Gastroenterology and Hepatology; Humans; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - methods; Laparoscopic gastric bypass; Laparoscopy - methods; Male; Middle Aged; Morbid obesity; Obesity, Morbid - surgery; Preoperative Care; Preoperative characteristics; Prospective Studies; Retrospective Studies; Surgery; Preoperative characteristics; Airway management; Complications; Anesthesia; Laparoscopic gastric bypass; Difficult laryngoscopy; Morbid obesity; Fiberoptic intubation
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2012.02.004

Abstract 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.