Anaesthetic outcomes in obese parturients: the effect of assessment in the high-risk clinic

Aslani, A.; Husarova, Viera; Ecimovic, P.; Loughrey, J. P. R.; McCaul, Conán

doi:10.1007/s11845-011-0762-9

Cited by 3 publications

(4 citation statements)

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“…Twelve studies with a total of 5678 patients were analysed the association between obesity and risk of Mallampati score ≥ 3 [ 7 , 14 , 23 , 24 , 26 , 28 – 34 ]. There were five case-control studies (two in the USA [ 23 , 28 ], one [ 27 ] in Germany, one in Denmark [ 35 ], and one in Ireland [ 32 ]) and 11 cohort studies (two in France [ 7 , 24 ], two in Turkey [ 25 , 31 ], one in Brazil [ 30 ], one in Israel [ 14 ], two in the USA [ 26 ], one in Greece [ 29 ] one in Italy [ 34 ] and one in the UK [ 33 ]). Two studies included parturients [ 25 , 31 ], and 14 recruited non-parturients [ 7 , 14 , 23 , 24 , 26 – 30 , 32 – 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…There were five case-control studies (two in the USA [ 23 , 28 ], one [ 27 ] in Germany, one in Denmark [ 35 ], and one in Ireland [ 32 ]) and 11 cohort studies (two in France [ 7 , 24 ], two in Turkey [ 25 , 31 ], one in Brazil [ 30 ], one in Israel [ 14 ], two in the USA [ 26 ], one in Greece [ 29 ] one in Italy [ 34 ] and one in the UK [ 33 ]). Two studies included parturients [ 25 , 31 ], and 14 recruited non-parturients [ 7 , 14 , 23 , 24 , 26 – 30 , 32 – 34 ]. Of the included studies, emergent tracheal intubation was used in two [ 23 , 25 ] and non-emergent tracheal intubation in the other 14 [ 7 , 14 , 24 , 26 – 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…The sniffing position was employed in five studies [ 7 , 14 , 24 , 26 , 28 ] and the supine position in 11 [ 23 , 25 , 27 , 29 – 34 ]. The definition of obesity as a BMI cut-off = 30 was applied in nine studies [ 7 , 14 , 23 , 25 , 28 – 32 ], whereas a BMI cut-off > 30 was used in seven studies [ 24 , 26 , 27 , 33 , 34 ]. The general characteristics of the published articles included in this meta-analysis are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

2018

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BackgroundObesity is a serious disorder and may bring about many difficulties of perioperative management. A systematic review was conducted to assess the association between obesity and difficult intubation.MethodsWe searched electronic databases for related reviews and references of meta-analyses on August 14, 2017. The databases of PubMed, Embase, and the Cochrane controlled trials register were searched compared obese with non-obese patients in which difficult intubation rate of the adult population were retrieved. Patients with a BMI ≥ 30 kg·m− 2 were considered obese. The primary outcome was difficult tracheal intubation; secondary outcomes were the rates of difficult laryngoscopy and Mallampati score ≥ 3. This review included papers published from 1998 to 2015.ResultsThis review included 204,303 participants in 16 studies. There was a statistically significant association between obesity and risk of difficult tracheal intubation (pooled RR = 2.04, 95% CI: 1.16–3.59, p = 0.01; I2 = 71%, p = 0.008, Power = 1.0). It also showed significantly association between obesity and risk of difficult laryngoscopy (pooled RR = 1.54, 95% CI: 1.25–1.89, p < 0.0001; I2 = 45%, p = 0.07, Power = 1.0), obesity and risk of Mallampati score ≥ 3 (pooled RR = 1.83, 95% CI: 1.24–2.69, p = 0.002; I2 = 81%, p < 0.00001, Power = 0.93). However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies (pooled RR = 3.41, 95% CI: 0.88–13.23, p = 0.08; I2 = 50%, p = 0.14) and the elective tracheal intubation (pooled RR = 2.31, 95% CI: 0.76–6.99, p = 0.14; I2 = 73%, p = 0.01), no associated with an increased risk of difficult laryngoscopy in the sniffing position (pooled RR = 2.00, 95% CI: 0.97–4.15, p = 0.06; I2 = 67%, p = 0.03).ConclusionObesity was associated with an increased risk of difficult intubation, difficult laryngoscopy and Mallampati score ≥ 3 in adults patients undergoing general surgical procedures. However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies and the elective tracheal intubation, no associated with an increased risk of difficult laryngoscopy in the sniffing position. Future analyses should explore the association of BMI and difficult airway.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

2018

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“…One London hospital reported that the indication for 26% of women presenting to their high-risk clinic was 'morbid obesity' 44 . Aslani et al demonstrated, in a cohort of 42 women with a mean BMI of 37.6 kg/m 2 (± 5.7), that those counselled to receive epidural analgesia requested it early in labour 45 . Those who subsequently required emergency caesarean section (n=5) successfully avoided general anaesthesia.…”

Section: The Antenatal Anaesthetic Consultationmentioning

confidence: 99%

Anaesthetic Management of Obese Parturients: What is the Evidence Supporting Practice Guidelines?

Eley

Zundert

Lipman

et al. 2016

Anaesth Intensive Care

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Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m 2 and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care. The concept behind early epidural analgesia is logical-site the epidural early, use it for surgical anaesthesia and avoid general anaesthesia if surgery is required. Experts support this recommendation, but there is weak supporting evidence. It is known that the management of labour epidurals in obese women is complicated and that women with extreme obesity require higher rates of general anaesthesia. Anecdotally, anaesthetists view and apply the early epidural recommendation inconsistently and the acceptability of early epidural analgesia to pregnant women is variable. In this topic review, we critically appraise these two practice recommendations. The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension ('top-up') in obese parturients would help inform practice, audit of local practice may better answer the question "is early epidural analgesia beneficial to obese women in my practice?".

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Difficult epidural placement in obese and non-obese pregnant women: a systematic review and meta-analysis

Uyl

Jonge

Groot

et al. 2019

International Journal of Obstetric Anesthesia

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Colorectal cancer (CRC) screening with colonoscopy is commonly used in patients who are candidates for liver transplantation. We initiated this study to define the risk-benefit ratio of performing screening colonoscopy in this population. A retrospective observational study of all consecutive patients undergoing colonoscopy during pre-liver transplantation screening between 2004 and 2017 was conducted. Endoscopic and pathological findings and clinical events potentially related to the colonoscopy in the 30 days after the procedure were registered and compared with a 30-day inpatient control time frame. A total of 858 colonoscopies were performed in 808 patients (65% male; median age, 55 years [interquartile range (IQR), 47-62]; median model for end-stage liver disease (MELD) score, 15 [IQR, 11-18]). CRC was found in 2 patients (0.2%), and advanced adenomas were found in 44 patients (5.4%). The only independent risk factor for an advanced neoplasm was age (odds ratio, 1.072 per year; 95% confidence interval, 1.031-1.115; P < 0.001). During the 30-day postprocedure period, 178 clinical events occurred in 128 patients compared with 101 clinical events in 72 patients in the control time frames (P < 0.001). After colonoscopy, there was a significantly increased risk for renal failure (P = 0.001) and gastrointestinal (GI) bleeding (P = 0.023). Presence of ascites and MELD score were identified as independent risk factors for acute renal failure and GI bleeding. During the study observation period, 53.5% of the screened population actually underwent liver transplantation. Conclusion: CRC screening in pre-liver transplantation patients is associated with a relatively low prevalence of CRC and an increased risk of postcolonoscopy complications such as acute renal failure and GI bleeding, especially in patients with advanced liver disease. Because the risk-benefit ratio of standard performance of a screening colonoscopy in this population appears questionable, alternative screening strategies should be considered. (Hepatology 2019;69:2598-2607). C olonoscopy is commonly performed as part of the standard screening for neoplastic lesions in patients who are candidates for liver transplantation, although international guidelines do not clearly state in which patients it should be mandatorily performed or might be omitted. (1-3) The prevalence of colorectal cancer (CRC) in liver transplantation candidates has not been well defined.

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Anaesthetic outcomes in obese parturients: the effect of assessment in the high-risk clinic

Cited by 3 publications

References 20 publications

The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis

Anaesthetic Management of Obese Parturients: What is the Evidence Supporting Practice Guidelines?

Difficult epidural placement in obese and non-obese pregnant women: a systematic review and meta-analysis

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