Degree of obesity is not associated with more than one intubation attempt: a large centre experience

Saasouh, Wael; Laffey, K.; Turan, Alparslan; Avitsian, Rafi; Zura, Andrew; You, Jing; Zimmerman, Nicole M.; Szarpak, Łukasz; Sessler, Daniel I.; Ruetzler, Kurt

doi:10.1016/j.bja.2018.01.019

Cited by 46 publications

(37 citation statements)

References 30 publications

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“…A signi cantly greater proportion of di cult laryngoscopy and tracheal intubation had been found in obese patients [11,12]. However, in our study, we found there was no signi cant difference between the easy and di cult groups (25.1±3.3 vs 25.7±2.5, P=0.261) which was in accordance with the study reported by Prakash et al [13].…”

Section: Discussionsupporting

confidence: 91%

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Zhou

Han

et al. 2020

Preprint

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Background: Airway management is one of the most important techniques in clinical anesthesia practice, and inappropriate airway management is related with airway injury, brain hypoxia, and even death. The patients with cervical spondylosis are often confronted with difficult laryngoscopy and are more prone to appear unexpected difficult airway, so it is important to figure out the most valuable predictor of difficult laryngoscopy in these patients.Methods: We randomly enrolled 270 patients undergoing elective cervical spine surgery and analyzed the cervical mobility data in predicting difficult laryngoscopy. The preoperative X-ray radiological indicators were measured by an attending radiologist. Cormack–Lehane scales were assessed during intubation, and patients with a class III or IV view were assigned to the difficult laryngoscopy group.Results: Univariate analysis showed that the hyomental distance (HMD, the distance between the hyoid bone and the tip of the chin) and the hyomental distance ratio (HMDR, the ratio between HMD in the extension position and the one in the neutral position) might not be suitable indicators in patients with cervical spondylosis. Binary multivariate logistic regression (backward-Wald) analyses identified two independent risk factors from the cervical mobility indicators that correlated best as a predictor of difficult laryngoscopy: modified Mallampati test (MMT) and C2C6AR (the ratio of the angle between a line passing through the bottom of the second cervical vertebra and a line passing through the bottom of the sixth cervical vertebra in the extension position over the one in the neutral position). The odds ratio (OR) and 95% CI were 2.292(1.093-4.803) and 0.493 (0.306-0.793), respectively. C2C6AR exhibited the largest area under the curve (0.714; 95% CI 0.633–0.794).Conclusions: C2C6AR based on preoperative X-ray images may be the most accurate predictor of cervical mobility indicators for difficult laryngoscopy in patients with cervical spondylosis.Trial registration: The study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR-ROC-16008598) on June 6, 2016.

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Section: Discussionsupporting

confidence: 91%

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Zhou

Han

et al. 2020

Preprint

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“…The majority of these scenarios arise due to poor visualization of laryngeal inlet -"epiglottis only view" ostensibly due to condition such as pharyngeal obstruction, obesity, limited cervical mobility etc. [5][6][7]. Situations in which glottic view is expected to improve by external laryngeal manipulationa readily available airway adjunct device (commonly known as bougie) is recommended to assist tracheal intubation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

et al. 2020

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Background: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.

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“…3 Today, obesity is a major public health and policy problem in many countries because of its prevalence, costs, and adverse health effects. 4 In this edition of the British Journal of Anaesthesia, Saasouh and colleagues 5 address the question of whether obesity or a high BMI is associated with difficult tracheal intubation. The authors used a retrospective database approach and electronic data sets of 67 702 adult patients having elective, non-cardiac surgery and requiring tracheal intubation at the Cleveland Clinic in the USA.…”

mentioning

confidence: 99%

“…Factors to improve tracheal intubation success 11 dif difficultdremain largely unknown in the study of Saasouh and colleagues. 5 As different parameters were used with a retrospective approach, it remains unclear which factors affect difficulty of intubation.…”

mentioning

confidence: 99%

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Big data for big patients: gaining insight into risks for tracheal intubation in obese patients

Hinkelbein

2018

British Journal of Anaesthesia

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Degree of obesity is not associated with more than one intubation attempt: a large centre experience

Cited by 46 publications

References 30 publications

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Preoperative X-ray C2C6AR is Applicable for Prediction of Difficult Laryngoscopy in Patients With Cervical Spondylosis

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

Big data for big patients: gaining insight into risks for tracheal intubation in obese patients

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