Abstract
BackgroundObesity is a serious disorder and may bring about many difficulties of perioperative management. A systematic review was conducted to assess the association between obesity and difficult intubation.MethodsWe searched electronic databases for related reviews and references of meta-analyses on August 14, 2017. The databases of PubMed, Embase, and the Cochrane controlled trials register were searched compared obese with non-obese patients in which difficult intubation rate of the adult population were retrieved. Patients with a BMI ≥ 30 kg·m− 2 were considered obese. The primary outcome was difficult tracheal intubation; secondary outcomes were the rates of difficult laryngoscopy and Mallampati score ≥ 3. This review included papers published from 1998 to 2015.ResultsThis review included 204,303 participants in 16 studies. There was a statistically significant association between obesity and risk of difficult tracheal intubation (pooled RR = 2.04, 95% CI: 1.16–3.59, p = 0.01; I2 = 71%, p = 0.008, Power = 1.0). It also showed significantly association between obesity and risk of difficult laryngoscopy (pooled RR = 1.54, 95% CI: 1.25–1.89, p < 0.0001; I2 = 45%, p = 0.07, Power = 1.0), obesity and risk of Mallampati score ≥ 3 (pooled RR = 1.83, 95% CI: 1.24–2.69, p = 0.002; I2 = 81%, p < 0.00001, Power = 0.93). However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies (pooled RR = 3.41, 95% CI: 0.88–13.23, p = 0.08; I2 = 50%, p = 0.14) and the elective tracheal intubation (pooled RR = 2.31, 95% CI: 0.76–6.99, p = 0.14; I2 = 73%, p = 0.01), no associated with an increased risk of difficult laryngoscopy in the sniffing position (pooled RR = 2.00, 95% CI: 0.97–4.15, p = 0.06; I2 = 67%, p = 0.03).ConclusionObesity was associated with an increased risk of difficult intubation, difficult laryngoscopy and Mallampati score ≥ 3 in adults patients undergoing general surgical procedures. However, there were no association of obesity and risks of difficult intubation compared with non-obesity in the cohort studies and the elective tracheal intubation, no associated with an increased risk of difficult laryngoscopy in the sniffing position. Future analyses should explore the association of BMI and difficult airway.
Highlights
Obesity is a serious disorder and may bring about many difficulties of perioperative management
102 articles were excluded for reasons such as obesity was not defined as body mass index (BMI) ≥ 30, difficult intubation or laryngoscopy was not mentioned, the study did not provide or obtain the effect estimates of relative risk (RR)/hazard ratio (HR)/odds ratio (OR) by calculation, tracheal intubation was not performed in a hospital
The findings revealed a significant association between obesity and the rate of difficult tracheal intubation, difficult laryngoscopy and Mallampati score ≥ 3
Summary
Obesity is a serious disorder and may bring about many difficulties of perioperative management. A systematic review was conducted to assess the association between obesity and difficult intubation. Obesity is a public health issue that leads to serious social, psychological and physical problems [1]. According to the World Health Organization survey, obesity rates have almost doubled worldwide since 1980 [2]. With the growing number of obese adults, increasing attention is being paid to difficult intubation (DI). Several tools (such as video laryngoscope, fibre-optic tracheal airway devices) can facilitate intubation or increase success rates, a DI can still be challenging for anaesthetists. A direct laryngoscope (DL) remains the most widely used device for tracheal intubation [5]
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