Difficult Tracheal Intubation in Obese Gastric Bypass patients

Niclas Dohrn, Thorbjørn Sommer, J. Bisgaard, Ebbe Ronholm, J. F. Larsen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) < 40, CLC > 2, ASA scores > 2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.
OriginalsprogEngelsk
TidsskriftObesity Surgery
Vol/bind26
Udgave nummer11
Sider (fra-til)2640-2647
ISSN0960-8923
DOI
StatusUdgivet - 2016

Fingeraftryk

Gastric Bypass
Body Mass Index

Bibliografisk note

ISI Document Delivery No.: EA3US Times Cited: 0 Cited Reference Count: 26 Dohrn, Niclas Sommer, Thorbjorn Bisgaard, Jannie Ronholm, Ebbe Larsen, Jens Fromholt 0 1 Springer New york 1708-0428

Citer dette

Dohrn, N., Sommer, T., Bisgaard, J., Ronholm, E., & Larsen, J. F. (2016). Difficult Tracheal Intubation in Obese Gastric Bypass patients. Obesity Surgery, 26(11), 2640-2647. https://doi.org/10.1007/s11695-016-2141-0
Dohrn, Niclas ; Sommer, Thorbjørn ; Bisgaard, J. ; Ronholm, Ebbe ; Larsen, J. F. / Difficult Tracheal Intubation in Obese Gastric Bypass patients. I: Obesity Surgery. 2016 ; Bind 26, Nr. 11. s. 2640-2647.
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title = "Difficult Tracheal Intubation in Obese Gastric Bypass patients",
abstract = "Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 {\%} and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) < 40, CLC > 2, ASA scores > 2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 {\%} of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.",
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Dohrn, N, Sommer, T, Bisgaard, J, Ronholm, E & Larsen, JF 2016, 'Difficult Tracheal Intubation in Obese Gastric Bypass patients', Obesity Surgery, bind 26, nr. 11, s. 2640-2647. https://doi.org/10.1007/s11695-016-2141-0

Difficult Tracheal Intubation in Obese Gastric Bypass patients. / Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.; Ronholm, Ebbe; Larsen, J. F.

I: Obesity Surgery, Bind 26, Nr. 11, 2016, s. 2640-2647.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Difficult Tracheal Intubation in Obese Gastric Bypass patients

AU - Dohrn, Niclas

AU - Sommer, Thorbjørn

AU - Bisgaard, J.

AU - Ronholm, Ebbe

AU - Larsen, J. F.

N1 - ISI Document Delivery No.: EA3US Times Cited: 0 Cited Reference Count: 26 Dohrn, Niclas Sommer, Thorbjorn Bisgaard, Jannie Ronholm, Ebbe Larsen, Jens Fromholt 0 1 Springer New york 1708-0428

PY - 2016

Y1 - 2016

N2 - Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) < 40, CLC > 2, ASA scores > 2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.

AB - Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass index (BMI) < 40, CLC > 2, ASA scores > 2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.

KW - Airway management Airway assessment Difficult tracheal intubation Obesity Gastric bypass body-mass index airway management neck circumference morbid-obesity lean patients laryngoscopy anesthesia predictor Surgery

U2 - 10.1007/s11695-016-2141-0

DO - 10.1007/s11695-016-2141-0

M3 - Journal article

C2 - 26989060

VL - 26

SP - 2640

EP - 2647

JO - Obesity Surgery

JF - Obesity Surgery

SN - 0960-8923

IS - 11

ER -

Dohrn N, Sommer T, Bisgaard J, Ronholm E, Larsen JF. Difficult Tracheal Intubation in Obese Gastric Bypass patients. Obesity Surgery. 2016;26(11):2640-2647. https://doi.org/10.1007/s11695-016-2141-0