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LETTERS TO THE EDITOR

Intubation in Morbidly Obese Patients

Département d’Anesthésie- Réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre cedex – France

To the Editor:

Brodsky, et al (1) found a positive relationship between neck circumference and the difficulty of endotracheal intubation in morbidly obese patients. However, they could not demonstrate any relationship between a history of sleep apnea syndrome (SAS) and the difficulty of intubation reported in previous studies (2,3). The lack of correlation may be because the diagnosis of SAS was apparently not confirmed by polysomnography. Indeed, history suggestive of SAS, per se, is not sensitive enough to make the diagnostic of SAS (4,5). It is possible that some of their patients did not have SAS, thus weakening the correlation.

Anecdotally, the two lines correlating in Table 2, the problematic intubation column, and the number of patients with or without SAS (Yes/No) should be reversed.

Footnotes

Dr. Brodsky does not wish to respond.

References

1. Brodsky JB, Lemmens HJM, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg, 2002; 94: 732–6.[Abstract/Free Full Text]
2. Hiremath AS, Hillman DR, James AL, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998; 80: 606–11.[Abstract/Free Full Text]
3. Gentil B, De Larminat JM, Boucherez C, Lienhart A. Difficult intubation and sleep apnoea syndrome. Br J Anaesth 1994; 72: 368.
4. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–35.[Abstract/Free Full Text]
5. Strollo PJ, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: 99–104.[Free Full Text]

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