Airway management in bariatric surgery patients, our experience in Qatar: A prospective observational cohort study

Atchyuta R Raju Vegesna,Moataz Mahmoud M Bashah,Kassim N Al-Anee,Jafar H Faraj

doi:10.5339/qmj.2020.2

Atchyuta R Raju Vegesna, Moataz Mahmoud M Bashah + Show 2 more

Open Access

https://doi.org/10.5339/qmj.2020.2

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Abstract

Background: Obesity has always been considered a criterion of difficult airway management, and many authors have tackled this subject. We are presenting our experience in airway management in obese patients undergoing bariatric surgery in Qatar and comparing the results with previous studies. Objective: The primary objective of this study was to explore the relationship between difficult mask ventilation and difficult intubation. The secondary objective was to identify other factors that may play a role in either difficulty such as gender, associated comorbidities, and the skill and experience of anesthetists. Design: This study was a prospective observational cohort study. Sample: A total of 401 patients were selected for various elective bariatric surgery in Hamad General Hospital, including 130 males and 271 females with an average body mass index(BMI) of 46.03 kg m− 2. Results: We used Pearson Chi-Square and Yates corrected Chi-square statistical tests in our statistical analysis. Neck circumference had a p value of 0.001 in both genders. The male gender had a p value of 0.052 and 0.012 in mask ventilation and difficult intubation, respectively. The Mallampati score had a p value of 0.56 and 0.006 in mask ventilation and intubation, respectively. In general, neck circumference, Mallampati score, gender, obstructive sleep apnea, and diabetes mellitus had greater negative effects on airway management than BMI alone. Conclusion: It was hard to intubate 25% of patients who had difficult mask ventilation (DMV). All DMV and 20 out of 23 of difficult intubation patients were in the high BMI group ( ≥ 40). Neck circumference, Mallampati score, and male gender were major independent factors; however, other factors, such as obstructive sleep apnea, and diabetes mellitus, should be kept in mind as additional risks.

Highlights

Managing the airway in obese patients, in general, is considered a challenge to many anesthetists
Difficult mask ventilation: The total number of patients with difficult mask ventilation (DMV) was 12 out of 401 (3%), including seven males compared with five females (p 1⁄4 0.052)
There is a tendency for DMV in patients with obstructive sleep apnea (OSA), and body mass index (BMI) $ 40 (Tables 1, 2)

Summary

Introduction

Managing the airway in obese patients, in general, is considered a challenge to many anesthetists In this segment of patients, the literature is inconclusive regarding the difficulties in airway management that may result in hypoxia and death.[1,2,3] In other articles, the validity of obesity and even the history of obstructive sleep apnea in patient airway management were questioned.[4,5,6] the criteria for difficult airway management (mask ventilation and intubation) in obese patients remain unresolved. Found in morbidly obese patients there was no relationship between the presence and severity of obstructive sleep apnea, BMI, or neck circumference and difficulty of intubation or laryngoscopy grade.[6] Only a Mallampati score of 3 or 4 or male gender predicted difficult intubation. Neck circumference, Mallampati score, gender, obstructive sleep apnea, and diabetes mellitus had greater negative effects on airway management than BMI alone. All DMV and 20 out of 23 of difficult intubation patients were

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