This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Gonzalez, H. Articles by Fourcade, O. Search for Related Content PubMed PubMed Citation Articles by Gonzalez, H. Articles by Fourcade, O. Related Collections Ambulatory Airway Preoperative Evaluation Patient Safety

---

AMBULATORY ANESTHESIOLOGY

The Importance of Increased Neck Circumference to Intubation Difficulties in Obese Patients

Hélène Gonzalez, MD^*, Vincent Minville, MD, MSc^*, Khedija Delanoue, MD^*, Michel Mazerolles, MD^*, Dominique Concina, MD^*, and Olivier Fourcade, MD, PhD^*

From the *Department of Anesthesiology and Intensive Care, GRCB 48, University Hospital of Toulouse, and Physiology Laboratory, INSERM U 858, Toulouse University Hospital Rangueil, Toulouse, France.

Address correspondence and reprint requests to Dr. Vincent Minville, Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Toulouse, France. Address e-mail to vincentminville{at}yahoo.fr.

Abstract

BACKGROUND: Using the intubation difficulty scale (IDS), we sought to confirm that obese patients are more difficult to intubate than lean patients. We assessed classical bedside tests and included neck circumference.

METHODS: We prospectively compared the incidence of difficult tracheal intubation in 70 obese [body mass index (BMI) 30 kg/m²] and 61 lean patients (BMI <30 kg/m²). The IDS scores, categorized as difficult intubation (IDS >5) or not (IDS 5), and the patient data, were compared between lean and obese patients. Preoperative measurements [BMI, neck circumference (at the level of the thyroid cartilage), width of mouth opening, sternomental distance, and thyromental distance], medical history of obstructive sleep apnea syndrome, and several scores (Mallampati, Wilson, El Ganzouri) were recorded. The view during direct laryngoscopy was graded, and the IDS was recorded. We then compared patients with IDS 5 and >5, concerning each item.

RESULTS: The results indicate that difficult tracheal intubation is more frequent in obese than in lean patients (14.3% vs 3%; P = 0.03). In the patients with IDS > 5, thyromental distance, BMI, large neck circumference, and higher Mallampati score were the only predictors of potential intubation problems.

CONCLUSION: We found that problematic intubation was associated with thyromental distance, increasing neck circumference, BMI, and a Mallampati score of 3. Neck circumference should be assessed preoperatively to predict difficult intubation.

This article has been cited by other articles:

				R. Maassen, R. Lee, B. Hermans, M. Marcus, and A. van Zundert A Comparison of Three Videolaryngoscopes: The Macintosh Laryngoscope Blade Reduces, but Does Not Replace, Routine Stylet Use for Intubation in Morbidly Obese Patients Anesth. Analg., November 1, 2009; 109(5): 1560 - 1565. [Abstract] [Full Text] [PDF]

				P. J. Neligan, S. Porter, B. Max, G. Malhotra, E. P. Greenblatt, and E. A. Ochroch Obstructive Sleep Apnea Is Not a Risk Factor for Difficult Intubation in Morbidly Obese Patients Anesth. Analg., October 1, 2009; 109(4): 1182 - 1186. [Abstract] [Full Text] [PDF]

				A. A. J. Van Zundert and R. A. Lee Intubation Difficulties in Obese Patients Anesth. Analg., March 1, 2009; 108(3): 1051 - 1051. [Full Text] [PDF]

				V. Minville, H. Gonzalez, and O. Fourcade Intubation Difficulties in Obese Patients Anesth. Analg., March 1, 2009; 108(3): 1051 - 1052. [Full Text] [PDF]

				G. A. Mashour, S. Kheterpal, V. Vanaharam, A. Shanks, L. Y.-J. Wang, W. S. Sandberg, and K. K. Tremper The Extended Mallampati Score and a Diagnosis of Diabetes Mellitus Are Predictors of Difficult Laryngoscopy in the Morbidly Obese Anesth. Analg., December 1, 2008; 107(6): 1919 - 1923. [Abstract] [Full Text] [PDF]

				V. Minville, H. Gonzalez, and O. Fourcade Neck Circumference and Difficult Intubation Anesth. Analg., November 1, 2008; 107(5): 1757 - 1757. [Full Text] [PDF]

				A. Hassani and G. Kessell Neck Circumference and Difficult Intubation Anesth. Analg., November 1, 2008; 107(5): 1756 - 1757. [Full Text] [PDF]

				More Evidence That Obesity Causes Difficult Intubation Journal Watch Emergency Medicine, April 11, 2008; 2008(411): 4 - 4. [Full Text]