JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (49)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Juvin, P.
Right arrow Articles by Desmonts, J.-M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Juvin, P.
Right arrow Articles by Desmonts, J.-M.

Anesth Analg 2003;97:595-600
© 2003 International Anesthesia Research Society


GENERAL ARTICLE

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

Philippe Juvin, MD PhD, Elisabeth Lavaut, MD, Hervé Dupont, MD, Pascale Lefevre, MD, Monique Demetriou, MD, Jean-Louis Dumoulin, MD, and Jean-Marie Desmonts, MD

Department of Anesthesia and Intensive Care, Bichat Claude-Bernard Hospital, Paris, France

Address correspondence and reprint requests to Philippe Juvin, MD, PhD, Department of Anesthesia and Intensive Care, Bichat Claude-Bernard Hospital, 46 Rue Henri Huchard, 75018 Paris, France. Address e-mail to philippe.juvin{at}bch.ap-hop-paris.fr

Whether tracheal intubation is more difficult in obese patients is debatable. We compared the incidence of difficult tracheal intubation in obese and lean patients by using a recently validated objective scale, the intubation difficulty scale (IDS). We studied 134 lean (body mass index, <30 kg/m2) and 129 obese (body mass index, >=35 kg/m2) consecutive patients. The IDS scores, categorized as difficult intubation (IDS >=5) or not (IDS <5), and the patient data, including oxygen saturation (SpO2) while breathing oxygen, were compared between lean and obese patients. In addition, risk factors for difficult intubation were determined in obese patients. The IDS score was >=5 in 3 lean and 20 obese patients (P = 0.0001). A Mallampati score of III–IV was the only independent risk factor for difficult intubation in obese patients (odds ratio, 12.51; 95% confidence interval, 2.01–77.81), but its specificity and positive predictive value were 62% and 29%, respectively. SpO2 values noted during intubation were (mean ± SD) 99% ± 1% (range, 91%–100%) and 95% ± 8% (range, 50%–100%) in lean and obese patients, respectively (P < 0.0001). We conclude that difficult intubation is more common among obese than nonobese patients. None of the classic risk factors for difficult intubation was satisfactory in obese patients. The high risk of desaturation warrants studies to identify new predictors of difficult intubation in the obese.

IMPLICATIONS: We report a difficult intubation rate of 15.5% in obese patients and 2.2% in lean patients. None of the risk factors for difficult intubation described in the lean population was satisfactory in the obese patients. We also report a high risk of desaturation in obese patients with difficult intubation.




This article has been cited by other articles:


Home page
Anesth. Analg.Home page
H. Gonzalez, V. Minville, K. Delanoue, M. Mazerolles, D. Concina, and O. Fourcade
The Importance of Increased Neck Circumference to Intubation Difficulties in Obese Patients
Anesth. Analg., April 1, 2008; 106(4): 1132 - 1136.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
Z. H. Khan, M. Gharabaghian, F. Nilli, M. Ghiamat, and M. Mohammadi
Easy Endotracheal Intubation of a Patient Suffering from Both Cushing's and Nelson's Syndromes Predicted by the Upper Lip Bite Test Despite a Mallampati Class 4 Airway
Anesth. Analg., September 1, 2007; 105(3): 786 - 787.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
A. Escobar, E. A. Davis, J. Ehrenwerth, G. A. Watrous, G. S. Fisch, Z. N. Kain, and P. G. Barash
Task Analysis of the Preincision Surgical Period: An Independent Observer-Based Study of 1558 Cases
Anesth. Analg., October 1, 2006; 103(4): 922 - 927.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
R. Amathieu, N. Smail, J. Catineau, M. P. Poloujadoff, K. Samii, and F. Adnet
Difficult Intubation in Thyroid Surgery: Myth or Reality?
Anesth. Analg., October 1, 2006; 103(4): 965 - 968.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
A. Lee, L. T. Y. Fan, T. Gin, M. K. Karmakar, and W. D. Ngan Kee
A systematic review (meta-analysis) of the accuracy of the mallampati tests to predict the difficult airway.
Anesth. Analg., June 1, 2006; 102(6): 1867 - 1878.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Public HealthHome page
S. Zhu, P. M. Layde, C. E. Guse, P. W. Laud, F. Pintar, R. Nirula, and S. Hargarten
Obesity and Risk for Death Due to Motor Vehicle Crashes
Am J Public Health, April 1, 2006; 96(4): 734 - 739.
[Abstract] [Full Text] [PDF]


Home page
Br J AnaesthHome page
F. R. Altermatt, H. R. Munoz, A. E. Delfino, and L. I. Cortinez
Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea
Br. J. Anaesth., November 1, 2005; 95(5): 706 - 709.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
E. C. Nemergut, A. S. Dumont, U. T. Barry, and E. R. Laws
Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery
Anesth. Analg., October 1, 2005; 101(4): 1170 - 1181.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
S. F. Reynolds and J. Heffner
Airway Management of the Critically Ill Patient: Rapid-Sequence Intubation
Chest, April 1, 2005; 127(4): 1397 - 1412.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
S. Gander, P. Frascarolo, M. Suter, D. R. Spahn, and L. Magnusson
Positive End-Expiratory Pressure During Induction of General Anesthesia Increases Duration of Nonhypoxic Apnea in Morbidly Obese Patients
Anesth. Analg., February 1, 2005; 100(2): 580 - 584.
[Abstract] [Full Text] [PDF]


Home page
Canadian J. AnesthesiaHome page
A. A. Matioc and J. Olson
Use of the Laryngeal TubeTM in two unexpected difficult airway situations: lingual tonsillar hyperplasia and morbid obesity: [L'usage du Laryngeal TubeTM dans deux situations d'intubation difficile inattendue : hyperplasie des amygdales linguales et obesite morbide]
Can J Anesth, December 1, 2004; 51(10): 1018 - 1021.
[Abstract] [Full Text] [PDF]


Home page
Canadian J. AnesthesiaHome page
A. M. H. Ho, D. C. Chung, E. W. H. To, and M. K. Karmakar
Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway: [Une obstruction totale des voies aeriennes pendant une anesthesie locale chez un patient eveille qui presentait deja une obstruction respiratoire partielle]
Can J Anesth, October 1, 2004; 51(8): 838 - 841.
[Abstract] [Full Text] [PDF]


Home page
Anesth. Analg.Home page
T. Gaszynski and P. Juvin
Standard Clinical Tests for Predicting Difficult Intubation Are Not Useful Among Morbidly Obese Patients * Response
Anesth. Analg., September 1, 2004; 99(3): 956 - 956.
[Full Text] [PDF]


Home page
Anesth. Analg.Home page
M. A. Rosenblatt, D. L. Reich, R. Roth, B. O. Ogunnaike, C. W. Whitten, and K. Jones
Bariatric Surgery and the Prevention of Postoperative Respiratory Complications * Response * Response
Anesth. Analg., June 1, 2004; 98(6): 1810 - 1811.
[Full Text] [PDF]


Home page
Anesth. Analg.Home page
R. B. P. Stasiuk
Should the Conventional Method for Routine Tracheal Intubation Be Questioned?
Anesth. Analg., June 1, 2004; 98(6): 1818 - 1818.
[Full Text] [PDF]


Home page
Anesth. Analg.Home page
T. Ezri, P. Szmuk, D. Warters, J. Katz, P. Juvin, E. Lavaut, H. Dupont, P. Lefevre, M. Demetriou, J.-L. Dumoulin, et al.
Tracheal Intubation in Obese Patients * Response
Anesth. Analg., January 1, 2004; 98(1): 272 - 273.
[Full Text] [PDF]


Home page
JWatch Emergency Med.Home page
Obesity Makes Intubation More Difficult
Journal Watch Emergency Medicine, September 24, 2003; 2003(924): 6 - 6.
[Full Text]




Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.