Predicting difficult airways using the intubation difficulty scale: a study comparing obese and non-obese patients

Lavi, Ron; Segal, D.; Ziser, Avishai

doi:10.1016/j.jclinane.2008.08.021

Cited by 47 publications

(27 citation statements)

References 14 publications

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“…An updated report of the American Society of Anesthesiologists Task Force on Management of the Difficult Airway has reviewed sore throat complaints after difficult airway in intubation and in LMA insertion: the incidence of sore throat was 20-41% after intubation and 10% after LMA insertion [24]. Intubation is known to be more difficult in obese patients [25,26]. Closed claims analysis shows that obesity, difficult intubation and intubation by inexperienced personnel are risk factors for severe airway injuries and pharyngooesophageal perforation [18].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the i‐gel and the LMA‐Unique laryngeal mask airway in patients with mild to moderate obesity during elective short‐term surgery

et al. 2011

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SummaryThe aim of our study was to compare leakage pressure, ease and time of insertion of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery. In this prospective, randomised crossover trial, we included patients with a body mass index (BMI) > 25 and < 35 kg.m )2 , and , age > 18 years, undergoing elective surgery in the supine position with an expected duration of surgery < 2 h. Leakage pressures, insertion difficulty, time and number of insertion attempts were evaluated. We included 50 patients consisting of 29 mildly (BMI > 25 and < 30 kg.mg) and 21 moderately (BMI > 30 and < 35 kg.mg

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Section: Discussionmentioning

confidence: 99%

Comparison of the i‐gel and the LMA‐Unique laryngeal mask airway in patients with mild to moderate obesity during elective short‐term surgery

et al. 2011

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“…Similarly study in obese patient shows that the Mallampati is good predictor for difficult intubation and the neck circumference also affect the prediction of difficult intubation. 11,12 These findings may not be true in our cases where the mean weight was only 55 +/-10 kg and we did not calculate the Body Mass Index.…”

Section: Discussionmentioning

confidence: 64%

Prevalence and prediction of difficult intubation in Nepalese population

Shah

2015

J. Soc. Anesth. Nep.

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Background: Prevalence of difficult intubation is estimated as 3 -18% during routine anesthesia. There are various bedside tests to predict the difficult intubation, like Mallampati test, Thyromental distance, Sternomental distance and mouth opening. However, the prevalence and prediction in Nepalese population is still not estimated. So this study is to see the prevalence and to compare the efficacy of airway parameters to predict the difficult intubation in Nepalese population.Methods: A prospective study was done to estimate the prevalence and prediction of difficult intubation in Nepalese population. During six months period, 182 patients who were undergoing routine surgery under General anesthesia were included in the study. Mallampati grading, thyromental distance, mouth opening and sternomental distance were recorded in preoperative assessment. Cormack and Lehane grading were done during intubation and Grade I and II are considered as easy intubation/ laryngoscopy and III and IV are considered as difficult intubation.Results: The prevalence of difficult intubation was 4.9%. Sensitivity of different tests were as follows; Mallampati test – 55%, thyromental distance – 33%, mouth opening – 22% and sternomental distance – 11%. The Specificity of the test as Mallampati test – 98%, thyromental distance – 89%, mouth opening – 96% and sternomental distance – 97%. So the Mallampati test is more sensitive and specific among the tests done.Conclusion: This prospective study shows that the prevalence of difficult intubation is not different in Nepalese population and the bedside predictors also are good tests that could be continued in our population.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 17-20

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“…Lavi et al . [24] in their study found that obese had higher IDS because of poor glottis exposure, need for increasing lifting force during laryngoscopy and need of laryngeal pressure to improve glottis exposure. A meta-analysis estimates overall prevalence of difficult intubation to be 4.5-7.5% respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparing ease of intubation in obese and lean patients using intubation difficulty scale

et al. 2014

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Background:Difficult tracheal intubation contributes to significant morbidity and mortality during induction of anesthesia. There are divided opinions regarding ease of intubation in obese patients. Moreover, the definition of difficult intubation is not uniform; hence we have use the Intubation Difficulty Scale (IDS) to find the incidence of difficult intubation in obese patients.Aims:The primary aim of the following study is to find out the incidence of difficult intubation in obese and lean patients using IDS and secondary aim is to assess the performance of bedside screening tests to predict difficult intubation, mask ventilation and laryngoscopy in obese and lean patients.Materials and Methods:A prospective, observational cohort study of 200 patients requiring general anesthesia were categorized into 100 each based on body mass index (BMI) into lean (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) groups. IDS score ≥5 was termed as difficult intubation. Pre-operative airway assessment included Mallampati score, mouth opening, neck circumference (NC), upper lip bite test, thyromental distance, sternomental distance (SMD) and head neck mobility. Patients having difficulty in mask ventilation and laryngoscopy was recorded.Results:Over all in 200 patients the incidence of difficult intubation was 9%. Obese patients were slightly more difficult to intubate than lean (11% vs. 7%, P = 0.049). Age >40 years, NC >35 cm, SMD <12.5 cm and restricted head neck mobility were factors which were associated with IDS ≥5. Multivariate analysis revealed SMD <12.5 cm to predict difficult intubation in obese patients. Obese patients were difficult to mask ventilate (6% vs. 1%, P = 0.043). There was no difference regarding grading of laryngoscopy between the two groups.Conclusion:Obese patients are difficult to mask ventilate and intubate. During intubation of obese patients who is more than 40 years age and SMD <12.5 cm, it is preferable to have a second skilled anesthesiologist.

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Predicting difficult airways using the intubation difficulty scale: a study comparing obese and non-obese patients

Cited by 47 publications

References 14 publications

Comparison of the i‐gel and the LMA‐Unique laryngeal mask airway in patients with mild to moderate obesity during elective short‐term surgery

Comparison of the i‐gel and the LMA‐Unique laryngeal mask airway in patients with mild to moderate obesity during elective short‐term surgery

Prevalence and prediction of difficult intubation in Nepalese population

Comparing ease of intubation in obese and lean patients using intubation difficulty scale

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