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Anesth Analg 2004;98:272-273
© 2004 International Anesthesia Research Society

LETTERS TO THE EDITOR

Tracheal Intubation in Obese Patients

Tiberiu Ezri, MD, Peter Szmuk, MD, David Warters, MD, and Jeffrey Katz, MD

Department of Anesthesia, Wolfson Medical Center Holon, Tel Aviv School of Medicine, Tel Aviv, Israel Department of Anesthesiology, The University of Texas Medical School, Houston, Texas

To the Editor:

In their recently published article, Juvin et al. (1) have shown that difficult endotracheal intubation is more common among obese than nonobese patients. However, as they correctly claim in their Introduction, this issue is debatable. Indeed, in two previous studies (2,3), we demonstrated that associated risk factors (age, male gender, poor dentition, TMJ pathology, Mallampati class 3 and 4, and a history of obstructive sleep apnea) rather than an increase in body mass index (BMI) may be responsible for this difficulty.

Furthermore, an increased amount of neck fat rather than the BMI magnitude itself may be a predictor of difficult laryngoscopy (4).

The authors also claim that a possible reason for these discrepancies is the lack of consensus on the definition of difficult intubation. We believe that to find a consensus in this issue, the laryngoscopy view grading (2–4) rather than intubation difficulty has to be sought as study end point. For this purpose, the commonly accepted Cormack and Lehane laryngoscopy view grading scale would be appropriate.

References

  1. Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97: 595–600.[Abstract/Free Full Text]
  2. Ezri T, Warters RD, Szmuk P, et al. The incidence of class zero airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade. Anesth Analg 2001; 93: 1073–5.[Abstract/Free Full Text]
  3. Ezri T, Medalion B, Weisenberg M, et al. Increased body mass index per se is not a predictor of difficult laryngoscopy. Can J Anaesth 2003; 50: 179–83.[Abstract/Free Full Text]
  4. Ezri T, Gewürtz G, Sessler DI, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia 2003; 58: 1111–4.[ISI][Medline]
 

Response

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

In Response:

We do not agree with Ezri et al. The Cormack and Lehane laryngoscopy view grading scale is less appropriate than IDS to identify difficult intubation. Difficult laryngoscopy is not always associated with difficult intubation. This is often the case in obese patients, asdemonstrated in our study: the incidence of difficult laryngoscopy was similar in obese and lean patients. In addition, some patients were difficult to intubate while laryngoscopy was easy. In fact, factors complicating laryngoscopy do not reflect the full spectrum of complex events that can make intubation difficult or easy. Therefore, the commonly accepted Cormack and Lehane laryngoscopy view grading scale is not appropriate to assess difficult intubation in obese patients.





This Article
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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