Difficult Tracheal Intubation Is More Common in Obese Than in Lean Patients

Juvin, Philippe; Lavaut, Elisabeth; Dupont, Hervé; Lefevre, P.; Demetriou, M.; Dumoulin, Jean-Louis; Desmonts, Jean-Marie

doi:10.1213/01.ane.0000072547.75928.b0

Cited by 472 publications

(324 citation statements)

References 25 publications

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“…Even if the need for awake intubation had been diminished by more frequent use of VL, it is also conceivable that such a decrease could have been masked by a concomitant rise in awake intubation for an increasing population of obese patients 10 in whom a higher incidence of anticipated difficult airway management might be expected. [11][12][13][14][15][16][17][18][19][20] While the overall incidence of awake tracheal intubation was 1.06% of GETA cases, there was substantial variability in the rate (0-3.4 per 100 GETA cases) at which individual attending staff performed the procedure. These results were not controlled for subspecialty practice (e.g., anesthesiologists performing mainly regional vs neuroanesthesia), although anecdotally, the four individuals with the two lowest and the two highest rates of awake intubation had similar practice profiles (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study Incidence, taux de réussite et complications de l'intubation trachéale chez 1554 patients éveillés sur une période de 12 ans: une étude de cohorte historique AbstractPurpose Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) at our institution. Methods The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling. Results Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4 -4 incidenceÁyear -1 ; 95% confidence interval [CI]: -3.0 -4 to 3.0 -5 ; P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidenceÁyear -1 ; 95% CI: 0.076 to 0.083; P \ 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011)(2012)(2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. Conclusions At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway. RésuméObjectif L'intubation trachéale du patient éveillé, qu'on appelle aussi intubation vigile, est une alternative recommandée dans certaines situations précises pour

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Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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“…All such anatomic factors may complicate visualization during a laryngoscopy. 86,87 This scenario may even become more complicated due to the difficulty to maintain a patent airway before endotracheal intubation, problems to manage ventilation with a face mask and a quick desaturation caused by a lower FRC (presence of atelectasis in dependent regions), 88,89 which is the result of a reduced expiratory reserve volume; all this affects obese patients' capacity to tolerate extended apnea periods 90 and, in the end, the period before oxygen arterial desaturation is brief. 91 Among adults, neither obesity nor BMI were associated with a predicted difficult intubation.…”

Section: Airwaysmentioning

confidence: 99%

The obese child in the Intensive Care Unit. Update

Fuentes¹,

L²,

et al. 2016

Arch Argent Pediat

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Given that childhood obesity is an epidemic, the frequency of critically-ill patients who are overweight or obese seen at intensive care units has increased rapidly. Adipose tissue is an endocrine organ that secretes a number of protein hormones, including leptin, which stands out because it regulates adipose tissue mass. The presence of arterial hypertension, metabolic syndrome, diabetes mellitus, respiratory disease and chronic kidney disease may become apparent and complicate the course of obese pediatric patients in the Intensive Care Unit. Obesity management is complex and should involve patients, their families and the medical community. It should be coordinated with comprehensive government health policies and implemented in conjunction with a change in cultural context

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“…Juvin et al reported a 15.5% rate of difficult tracheal intubation in obese patients compared with a 2.2% rate in lean patients. 17 While some studies showed an association between obesity and difficult intubation, controversy still exists, and there is insufficient evidence to support increased BMI alone as an independent predictor of difficult laryngoscopy or difficult intubation. 17,18 In a cohort of 91,332 consecutive patients, a BMI [ 35 kgÁm 2 was found to be a statistically significant predictor of difficult and failed intubation.…”

Section: Direct Laryngoscopy and Intubationmentioning

confidence: 99%

“…17 While some studies showed an association between obesity and difficult intubation, controversy still exists, and there is insufficient evidence to support increased BMI alone as an independent predictor of difficult laryngoscopy or difficult intubation. 17,18 In a cohort of 91,332 consecutive patients, a BMI [ 35 kgÁm 2 was found to be a statistically significant predictor of difficult and failed intubation. 19 Conversely, Erzi et al found that BMI was not an independent predictor of direct laryngoscopy view; 20 however, in this study, the combination of BMI and abnormal upper teeth was a significant predictor of difficult laryngoscopy.…”

Section: Direct Laryngoscopy and Intubationmentioning

confidence: 99%