Neck circumference as a predictor of difficult intubation and difficult mask ventilation in morbidly obese patients

Riad, Waleed; Vaez, Mercedeh; Raveendran, Ravi; Tam, Amanda D.; Quereshy, Fayez A.; Chung, Frances; Wong, David T.

doi:10.1097/eja.0000000000000324

Cited by 103 publications

(96 citation statements)

References 19 publications

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“…We took the value with highest TPR and FPR on the graph as our cut off [ Figure 1 ]. Our upper limit for RHTMD was 17.13 and was lower than in other Indian studies[ 13 14 16 ] but was similar to that reported by Liaskou et al . [ 19 ] Schmitt proposed an RHTMD of 25 or more for prediction of difficult laryngoscopy in Caucasians.…”

Section: Discussionsupporting

confidence: 90%

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Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan

Chockalingam

2017

Indian J Anaesth

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Background and Aims:Most studies on upper airway are conducted based on airway measurements in the western population. We set out to find the normal values of upper airway measurements in South Indian population. The aim of this study was to perform various upper airway examinations and to set standards for normal measurements in the South Indian population as well as to analyse the data for predictors of difficult intubation.Methods:This prospective observational study was conducted in a tertiary cancer hospital in Southern India. Airway assessment parameters, including modified Mallampati classification (MPC), upper lip bite test (ULBT), sternomental distance, thyromental distance (TMD), and the inter-incisor distance were documented for 2004 patients meeting the inclusion criteria. Laryngoscopic view after induction was graded as per Cormack and Lehane's (CL) classification. Any CL ≥3 was considered to be difficult laryngoscopy. The collected data (2004 cases) was analyed with SPSS software version 17. Receiver operating characteristics (ROC) curve was used to determine cut-offs in the population. Sensitivity, specificity, positive and negative predictive value were computed.Results:MPC, ULBT, and ratio of height to TMD (RHTMD) predicted difficult intubation with sensitivity of 40.86%, 45.53% and 64.60%, respectively and these were statistically significant with P < 0.001. Using the area under the curve of the ROC curve and discrimination analysis normal RHTMD in our population had a cut off value of 17.1.Conclusion:The cut off value for RHTMD to predict difficult laryngoscopy in the South Indian population is 17.1.

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Section: Discussionsupporting

confidence: 90%

“…There are multiple studies stating male gender as a predictor of difficult intubation. [ 16 ] Our study too had more males with difficult laryngoscopy. We had a total of 429 males with 22.8% (98) having difficult laryngoscopy compared to 1575 females with 10.09% (159) difficulty.…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan

Chockalingam

2017

Indian J Anaesth

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“…Neck circumference of >42 cm and BMI of >50 kg·m −2 (super obesity) are two independent predictors of difficult intubation 15. Dixit et al16 observed that 44.4% of super obese patients had C-L grade 3 and 4 views compared to 20.4% of the morbidly obese patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the glottic view during video-intubation in super obese patients: a series of cases

Gaszyński¹

2016

TCRM

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Videolaryngoscopes improve the view of the entry to the larynx in morbidly obese patients. Super obesity is one of the risk factors for difficult mask ventilation as well as difficult intubation. Super obese patients should be intubated awake either with a fiber-optic scope or with a videolaryngoscope. The glottic view during video-intubation in super obese patients using different devices was compared. The McGrath MAC (MGM) was used in all patients and then compared to the King Vision (KV) in three patients, the APA videolaryngoscope in two patients and the Airtraq Avant with a video camera in four patients. The pictures were of the same patient for two used devices. All obtained images were analyzed using the Percentage of Glottic Opening (POGO) scale. The POGO score for the MGM was better than for the KV and the APA but comparable to the Airtraq device. The images were processed electronically, and the best view of the laryngeal inlet that was obtained by the evaluated devices in the same patient was superimposed onto the other one and then compared.

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“…Superobese patients with BMI ≥ 50 kg/m 2 and neck circumference > 42 cm are considered to be 50 times more likely to experience difficulties in intubation [5]. In our patient, restenosis of the previously resected trachea was a factor for refusing anesthesia and any elective surgery in non-experienced centers.…”

Section: Discussionmentioning

confidence: 63%

Laparoscopic sleeve gastrectomy in a superobese patient with restenosis of the trachea

Ilić

Putnik²

2019

Srp Arh Celok Lek

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Introduction Superobese group of patients with body mass index (BMI) ≥ 50 kg/m 2 have higher technical intraoperative problems, higher morbidity, and mortality. Indications for the metabolic procedure are widening and minimally invasive operation dictates that both patients and surgeons face previously assumed "general contraindication" for a surgical bariatric/metabolic procedure. Case outline We present a superobese patient with restenosis of the trachea, chronic obstructive pulmonary disease, sleep apnea, and cardiomyopathy with panniculus grade IV, in whom, as a multidisciplinary team, we simultaneously performed permanent tracheostomy, laparoscopic sleeve gastrectomy, and panniculectomy. Conclusion Quality of life after the bariatric operation must be a leading factor in regard to the approach to a difficult patient, with the operation adaptable enough to fit all demands.

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Neck circumference as a predictor of difficult intubation and difficult mask ventilation in morbidly obese patients

Cited by 103 publications

References 19 publications

Ethnicity and upper airway measurements: A study in South Indian population

Ethnicity and upper airway measurements: A study in South Indian population

Comparison of the glottic view during video-intubation in super obese patients: a series of cases

Laparoscopic sleeve gastrectomy in a superobese patient with restenosis of the trachea

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