Difficult Intubation In Obese Patients Research Articles

Can chin-nape circumference and the ratio of neck circumference to chin-nape circumference predict difficult mask ventilation or difficult intubation in obese patients?

We aimed to evaluate the success of the ratio of chin-nape circumference (CNC) and neck circumference (NC) to CNC in predicting difficult mask ventilation (DMV) or difficult intubation (DI). Eighty-seven obese patients (body mass index ≥ 30) were evaluated between September 15, 2019 and September 15, 2020. Mallampati score, mouth opening, upper lip bite test, distance between incisors, thyromental distance (TMD), sternomental distance (SMD), and thyromental height were recorded. NC and CNC were measured in a neutral position. The ratio of NC to TMD and the ratio of NC to CNC were calculated. Mask ventilation was graded according to the method described by Han et al (Grade 3 or 4 equals DMV). DI assessment was performed using the intubation difficulty scale (IDS, IDS < 5 equals easy intubation, IDS ≥ 5 equals DI). Logistic regression analysis was performed to identify the variables thought to be effective in DMV and DI. Receiver operating characteristic curves were generated for each parameter considered effective. DMV was found in 17.2% (n = 15) of the patients included in the study, and DI was found in 16.1% (n = 14). The relationship between DMV and age, male gender, obstructive sleep apnea syndrome, NC, ratio of NC to TMD, ratio of NC to SMD, ratio of NC to CNC, and CNC was significant. Male gender and NC >45.5 cm were independent risk factors for DMV. The relationship between DI and distance between incisors, NC, ratio of NC to TMD, ratio of NC to SMD, and CNC was significant. A distance between the incisors < 4.85 cm and a NC > 41.5 cm were found to be independent risk factors for DI. CNC may predict DMV and DI in obese patients. The ratio of NC to CNC may predict DMV in obese patients.

Prognostic value of the intubation difficulty scale in bariatric surgery

The objective was to assess the predictive value of the risk scale for difficult intubation in obese patients. Materials and methods. The object of the study was 110 patients (90 women and 20 men) operated on as planned in 2022. The mean age of the patients was 42 ± 11 years. The median body mass index (BMI) was 43.7 kg/m 2 (Q1–Q3: 37.9–49.1). All patients underwent a standard preoperative examination with the identification of the risk of difficult airways according to the intubation difficulty scale (IDS): mouth opening, neck mobility, mandibular protrusion, Mallampati class, sternomental and thyromental distances, and history of previous intubations were assessed. Results. Difficult intubation (3–4 degrees according to Cormack–Lehane) were detected in 19 patients (17.3 %). ROC-analysis revealed the dependence of the probability of difficult intubation on the total points on the intubation difficulty scale. The area under the ROC curve was 0.809 ± 0.063 with 95 % CI: 0.685 – 0.932. The model was statistically significant (p &lt; 0.001). The cut-off point value for the total points on the intubation difficulty scale, which corresponded to the highest value of the Youden index, was 4. The sensitivity and specificity of the model were 100.0 % and 47.3 %, respectively. Significant differences (p &lt; 0.001) were found in the analysis of the risk of difficult intubation depending on the total points on the intubation difficulty scale. The most significant differences (p &lt; 0.001) were demonstrated by the mouth opening width and neck mobility. There were no differences (p = 0.547) when analyzing the history of difficult airways and nighttime snoring. Conclusion. Overall, the intubation difficulty scale showed predictive value in terms of assessing the risk of difficult airways (p = 0.002, χ2 = 13.230). The most reliable indicators for predicting the risks of difficult intubation were mouth opening less than 4 cm (p &lt; 0.001, χ2 = 11.185) and head and neck flexion in the atlanto-occipital joint less than 90о (p &lt; 0.001, χ2 = 10.858). Assessment of thyromental and sternomental distances, mandibular protrusion ability, and Mallampati class also showed statistical significance. Prior history of difficult intubation and nighttime snoring showed no statistically significant risk in predicting difficult airways (p = 0.547, χ2 = 0.363).

Evaluation of neck-circumference- thyromental- distance ratio as a predictor of difficult intubation: A prospective, observational study.

Preoperative identification of difficult airway and subsequent planning is of utmost importance for a patient's safety. Previous studies have identified the ratio of the neck circumference (NC) to the thyromental distance (TMD); NC/TMD as a reliable predictor of difficult intubation in obese patients. But there is a lack of studies evaluating the NC/TMD in non-obese patients. Therefore, the aim of this study was to compare the NC/TMD as a predictor of difficult intubation in both obese and non-obese patients. A prospective, observational study was conducted after obtaining institutional ethics committee clearance and written and informed consent from each patient. One hundred adult patients undergoing elective surgeries under general anaesthesia with orotracheal intubation were included in this study. Difficulty in intubation was assessed using the Intubation Difficulty Scale. The NC/TMD was calculated and the predictive accuracy of NC/TMD and other established parameters in obese and non-obese patients were compared. Univariate logistic regression analysis showed that gender, weight, body mass index, inter-incisor gap, Mallampati classification, NC, TMD, sternomental distance, and NC/TMD had a significant association with difficult intubation. NC/TMD has a higher sensitivity, specificity, and positive and negative predictive value with better predictability in comparison to other parameters. The NC/TMD is a reliable and better predictor of difficult intubation in both obese and non-obese patients in comparison to NC, TMD, and sternomental distance alone.

No: 4880 Diagnostic accuracy of combined Mallampati and Wilson score to predict difficult intubation in obese patients: a descriptive cross-sectional study

No: 4880 Diagnostic accuracy of combined Mallampati and Wilson score to predict difficult intubation in obese patients: a descriptive cross-sectional study

Genel Anestezi Uygulanan Obez Hastaların Antropometrik Ölçümlerinin Zor Entübasyonla İlişkisi: Prospektif Çalışma

Genel Anestezi Uygulanan Obez Hastaların Antropometrik Ölçümlerinin Zor Entübasyonla İlişkisi: Prospektif Çalışma

Significance of Ratio of the Neck Circumference and Thyromental Distance as a Predictor of Difficult Intubation in Obese Patients

Objective: To ascertain the diagnostic accuracy of raised neck circumference to thyromental distance ratio (NC/TMD) for difficulty in intubation among patients with obesity keeping grades III and IV of Cormack and Lehane's score as the gold standard.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Anesthesiology Department, Combined Military Hospital Rawalpindi, from Jul to Dec 2017.&#x0D; Methodology: One hundred and thirty obese patients who had to undergo surgery under general anaesthesia were included in the study. All the patients underwent measurement of neck circumference to thyromental distance ratio, and raised neck circumference to thyromental distance ratio was noted. Difficult intubation was labelled according to the grades III and IV of Cormack and Lehane's score.&#x0D; Results: In this study, 130 cases were included. Fifty-eight patients were males, and 72 were females. Diagnostic accuracy of raised neck circumference to thyromental distance ratio for difficulty in intubation among patients who were obese, was recorded where sensitivity was 83.87%, and specificity was found to be 91.92%, positive predictive value as 76.47%, negative predictive value as 94.79%, the accuracy rate was calculated as 90%.&#x0D; Conclusion: Our study showed that difficulty in intubation is more frequent in patients who are obese and the neck circumference to thyromental distance ratio is a reliable method for foreseeing difficult intubation compared to other established predictors with cut off value of 5.0.

9: Evaluation of the neck circumference to thyromental distance ratio as a predictor of difficult intubation-A prospective observational study

Background and Aims:Preoperative identification of difficult airway and subsequent planning is of utmost importance for patient safety. Previous studies have identified neck circumference to thyromental distance ratio (NC/TMD) as a reliable predictor of difficult intubation in obese patients.[1] But, there is lack of a reported study evaluating NC/TMD in the non-obese patients. The aim of our study was to evaluate the NC/TMD as a predictor of difficult intubation in both obese and non-obese patients.Methods::A prospective observational study was conducted after obtaining Institutional Ethics Committee clearance and written informed consent from each patient. Hundred adult patients undergoing elective surgeries under general anaesthesia with orotracheal intubation were included in this study. Difficulty in intubation was assessed using Intubation Difficulty Scale (IDS>5).[2] The NC/TMD was calculated and was compared with other established parameters in predicting difficult intubation in both obese and non-obese patients. Statistical Package for the Social Sciences (SPSS) software (version 22.0) was used for statistical analysis.Results:Univariate logistic regression analysis showed that sex, weight, body mass index, inter-incisor gap, Mallampati classification, neck circumference, thyromental distance, sternomental distance and NC/TMD had a significant association with difficult intubation. NC/TMD has a higher sensitivity, specificity, PPV and NPV with a large area under curve (AUC) (P = 0.000) in comparison to other parameters.Conclusion:The NC/TMD is a reliable and better predictor of difficult intubation in both obese and non-obese patients in comparison to neck circumference, thyromental distance, sternomental distance alonePredictorGroupSensitivitySpecificityPPVNPVAUC P NC/TMDNon obese (>4.950)100.0087.2761.11100.000.9790.000Obese (>5.050)94.7473.3381.8291.670.9120.000BMITotal83.3372.8656.8291.070.870<0.001Neck circumferenceNon obese (>35.5 cm)90.9161.8232.2697.140.8290.001Obese (>35.5 cm)84.2160.0072.7375.000.7580.011Thyromental distanceNon obese (<7.250 cm)100.0069.0939.29100.000.9020.000Obese (<7.250cm)89.4773.3380.9584.620.8280.001Sternomental distanceNon obese (<14.5 cm)81.8280.0045.0095.650.7830.003Obese (<15.5cm)78.9526.6757.6950.000.5160.876

Diagnostic Accuracy of Combined Mallampati and Wilson Score to Predict Difficult Intubation in Obese Patients: A Descriptive Cross-sectional Study

BackgroundAirway protection during anesthesia is often the primary concern of anesthetists when working with obese patients and always is a difficult task due to increased exposure to harmful effects of apnea, hypoxia, and impaired respiratory mechanics.ObjectivesThe primary goal of this research was to determine the diagnostic accuracy of combined Mallampati and Wilson score in detecting difficult intubation in obese patients undergoing surgery by taking the Cormack-Lehane grading on direct laryngoscopy and intubation as the gold standard.MethodsThis descriptive cross-sectional study was done in 300 obese patients with BMI > 29.9 kg/m2. Modified Mallampati and Wilson score was recorded preoperatively for each patient in the sitting position by the primary investigator. Endotracheal intubation grades were also recorded, and grades IIb, III, and IV were regarded as difficult intubation according to the Cormack-Lehane intubation classification.ResultsThe mean age was 46.76 ± 15.57 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the combined Mallampati and Wilson score for detecting difficult laryngoscopy and difficult intubation were 75.0, 98.8, 92.9, 95.0, and 94.6%, respectively.ConclusionsCombined Mallampatti and Wilson score is highly accurate in the initial diagnostic workup of obese patients at risk of difficult intubation. It is easy to calculate and lower the risk of intubation-related complications and failure.

Diagnostic Accuracy of Neck Circumference and Thyromental Distance Ratio for Assessing Difficult Intubation in Obese Patients: a Validation Study

Various tools for airway assessment are include Mallampati score, upper lip bite test, Wilson scoring and extent of mouth opening; none have high investigative precision especially in obese patients. Objectives: To assess the diagnostic accuracy of neck circumference and thyromental distance ratio for assessing difficult intubation in obese patients using intubation difficulty score as gold standard. Setting: Department of Anesthesiology in East and West operation theatres of Mayo hospital Lahore. Duration: 12 months (From Oct 2015 – Oct 2016) Sample Size: 220 obese patients Methods: Patients undergoing elective surgery were enrolled. Height, weight and body mass index was documented. At the cricoid cartilage level, the neck circumference was measured. All tracheal intubations were conducted by a three-year-experienced anaesthesiologist who was unaware of the study's findings. Cormack and Lehane's grading system was used to rate the laryngoscopy image. Difficult intubation was assessed according to intubation difficulty scoring. Results: The diagnostic accuracy of neck circumference and thyromental distance ratio in assessment of difficulty intubation (DI) among obese patients was 47%, sensitivity 85% and specificity of 37%. Conclusion: NC/TM ratio was a good interpreter in assessing difficult intubation in obese patients. This variable can be incorporated in our preoperative assessment for difficult intubation (DI). It is simple, requires very less time and is economical. Keywords: Airway management, obese, difficult intubation, neck circumference, laryngoscopy, tracheal intubation.

Comparison of airway assessment tests for prediction of difficult intubation in obese patients: importance of thyromental height and upper lip bite test.

Prediction of difficult intubation (DI) has remained challenging for anesthesiologists and validity of airway assessment tests has not been fully investigated. This study aims to compare predictive values of these tests for prediction of DI in obese patients. One hundred ninety-six patients with Body Mass Index (BMI) ≥30 kg/m2 were included in this prospective study. Variables including intubation Difficulty Scale (IDS), thyromental height (TMH), hyomental distance (HMD) in extent and neutral neck position, HMD ratio (HMDR), sternomental distance (SMD), thyromental distance (TMD), ratio of height to TMD (RHTMD), width of mouth opening (MO), mandibular length (ML), Cormack-lehane (C-L) grade, upper lip bite test (ULBT), history of snoring, and obstructive sleep apnea were collected. Multiple logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine independent predictors of DI (defined as IDS≥5) and their cut off points. DI and difficult laryngoscopy (defined as C-L grade ≥3) were observed in 23% and 24.5% of the study population, respectively. Multiple logistic regression identified TMH (Odds ratio (OR):0.28, 95% confidence interval (CI):0.14-0.58, P=0.001), BMI (OR:1.18, 95% CI: 1.11-1.26, P<0.001), HMDR (OR:0.45, 95% CI:0.36-0.56, P<0.001) and ULBT (OR: 3.91, 95% CI: 2.14-7.14, P<0.001) as independent predictors of DI. Sensitivity of TMH<4.8 cm, BMI>34.9 kg/m2, HMDR<1.4 and ULBT class ≥2 were determined as 75.1%, 73.3%,62.3% and 93.3% respectively. TMH and ULBT had the highest sensitivity for prediction of DI in obese patients in this study and it is recommended to be considered as part of airway assessment in this patient population.

Correlation between neck circumference measurement and obesity type with difficult intubation in obese patients undergoing elective surgery

Background/Aim: The number of obese patients undergoing elective surgery is increasing day by day. However, there are conflicting data in the literature about factors predicting difficult tracheal intubation in obese patients. The aim of this study was to evaluate the commonly used predictors of difficult intubation in obese patients (body mass index (BMI) >35 kg/m2) who wish to undergo elective surgery and to examine the association of neck circumference and obesity type with difficult intubation. Methods: This observational, cross-sectional, prospective study was performed after obtaining approval from the ethics committee. Obese patients over the age of 18 years, requiring tracheal intubation, undergoing elective surgery, and with a BMI greater than 35 were included in this study. Patients with a history of cervical spine anomaly or trauma, congenital facial anomaly or trauma affecting this region, those who would undergo emergency surgery, patients with a known history of difficult airway or upper respiratory tract disease, and those with planned awake intubation were excluded from the study. Preoperative anesthetic evaluation was performed for all patients, their relevant measurements were obtained, and medical histories were taken as required for the study. The association of the patients’ BMI, Mallampati classification, thyromental distance, Cormack–Lehane grade, obstructive sleep apnea, neck circumference, and obesity type with difficult intubation was evaluated. Preoperative and peroperative measurements were recorded in the follow-up forms. Results: A total of 85 patients, 62 females and 23 males, between the ages of 19 and 77 years were included in this study. A significant difference was found in the patients’ BMI, neck circumference, thyromental distance, Mallampati classifications, and Cormack–Lehane grades in terms of intubation difficulty (P 50 cm increased the risk of difficult intubation 8.323 times. Conclusion: Neck circumference and thyromental distance are significant predictors for difficult intubation and laryngoscopy in morbidly obese patients.

Apnoeic Oxygenation during Simulated Difficult Intubation in Obese Patients: Comparison of Buccal Ring, Adair and Elwyn Tube Versus Nasal Cannula: A Prospective Randomized Controlled Trial.

Background:Apnoeic oxygenation is an established method of increasing safe apnoea times during intubation and this is of more importance in obese patients. The usefulness of buccal Ring, Adair and Elwyn (RAE) oxygenation has been established in previous studies, however a head-to-head comparison with nasal cannula (NC) is lacking.Aim:The aim of this study was to compare apnoea time with buccal RAE (BR) versus NC in obese patients.Setting and Design:This was a prospective, nonblinded randomized controlled trial conducted in a tertiary hospital where fifty American Society of Anaesthesiologists Physical Status Class I and II, obese patients with body mass index ≥30, posted for elective surgery were included.Materials and Methods:Following adequate preoxygenation and standard induction of anaesthesia, a prolonged simulated difficult laryngoscopy was performed during which oxygen was provided via either BR or NC. The primary outcome was time to desaturation to <95% or 10 min, which ever occurred first. Other outcomes recorded were lowest saturation, time to resaturation and highest end tidal carbon di oxide.Statistical Analysis:Mean with standard deviation (SD) or median with inter quartile range were used for continuous variables and absolute number with percentage were used for categorical variables. The primary outcome was analyzed using Kaplan-Meier survival curves, and log-rank tests were applied.Results:Patient characteristics were similar in both arms. The mean apnoea time in seconds (SD) in the BR group, 375.3 (116.6) was higher than the NC group 316.1 (94.1), P = 0.054. From the Kapan Meier curves the probability of desaturating to <95% was earlier in the NC group than the BR group (P = 0.092). The other outcomes were similar in both groups.Conclusion:This is the first study that demonstrates that oxygenation via a BR is better than NC in providing apnoeic oxygenation in obese patients and can safely be used when NC are contraindicated.

Neck circumference to thyromental distance ratio: Is a reliable predictor of difficult intubation in obese patients?

Neck circumference to thyromental distance ratio: Is a reliable predictor of difficult intubation in obese patients? - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2019.0029, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

There is a new scale for difficult intubation in obese patients undergoing elective surgery-The neck circumference and other airway assessment test

There is a new scale for difficult intubation in obese patients undergoing elective surgery-The neck circumference and other airway assessment test

DIAGNOSTIC ACCURACY OF NECK CIRCUMFERENCE TO THYROMENTAL DISTANCE RATIO FOR DIFFICULT INTUBATION IN OBESE PATIENTS

Objectives: To determine the diagnostic accuracy of ratio of neck circumferenceto thyromental distance to predict the difficult intubation in obese patients by using Intubationdifficulty scale as gold standard. Study Design: Cross-sectional study. Place and Durationof Study: Jinnah Hospital, Department of Anesthesia, Lahore from August 2013 to July 2014.Methodology: 250 patients were included. Ratio of neck circumference to thyromental distancewas measured during preoperative assessment in all patients. Results: There were 59.2% malesand 40.8% females with mean age of patients was 37.13+11.64 years. 19.2% patients showeddifficult intubation and 80.8% easy. Sensitivity of NC/TM was 89.58% and Specificity 72.77% withpositive predictive value of 43.88% and Negative predictive value of 96.71%. Conclusion: Neckcircumference to thyromental distance ratio is sensitive method for determining the difficultintubation among obese patients.

INTUBATION IN OBESE PATIENTS

Objectives: To determine the diagnostic accuracy of ratio of neck circumferenceto thyromental distance to predict the difficult intubation in obese patients by using Intubationdifficulty scale as gold standard. Study Design: Cross-sectional study. Place and Durationof Study: Jinnah Hospital, Department of Anesthesia, Lahore from August 2013 to July 2014.Methodology: 250 patients were included. Ratio of neck circumference to thyromental distancewas measured during preoperative assessment in all patients. Results: There were 59.2% malesand 40.8% females with mean age of patients was 37.13+11.64 years. 19.2% patients showeddifficult intubation and 80.8% easy. Sensitivity of NC/TM was 89.58% and Specificity 72.77% withpositive predictive value of 43.88% and Negative predictive value of 96.71%. Conclusion: Neckcircumference to thyromental distance ratio is sensitive method for determining the difficultintubation among obese patients.

The Importance of Neck Circumference to Thyromental Distance Ratio (Nc/Tm Distance Ratio) as a Predictor of Difficult Intubation in Obese Patients Coming for Elective Surgery under General Anaesthesia in a Teritatry Care Hospital - A Prospective Observational Study

BACKGROUND AND OBJECTIVES : This study was done to assess the ability of neck circumference to thyromental distance ratio (NC/TM distance ratio) for predicting difficult intubation among obese patients coming for surgery under general anaesthesia. It enabled us to compare NC/TM distance ratio to routinely used Mallampati score and neck circumference as reliable tests for predicting difficult intubation. This study also identified incidence of difficult intubation among obese individuals. PATIENTS AND METHODS : After approval of institutional review board and ethical committee of Christian Medical College Vellore, 250 obese patients (body mass index greater than or equal to 30) within time frame of September 2014 and March 2015 was assessed preoperatively with the help of performa after obtaining informed consent. Neck circumference / thyromental distance ratio (NC/TM distance ratio) was calculated from the performa. Validated Intubation difficulty score (IDS score) for each obese patient was assessed intra operatively by the anaesthetist who performed intubation . The entire study population were divided into easy and difficult intubation groups based on the IDS score. IDS score greater than or equal to five was considered as difficult intubation. NC/TM distance ratio greater than or equal to five was correlated with IDS score greater than or equal to five. The study assessed the statistical significance of NC/TM distance ratio and difficult intubation by univariate and multivariate logistic regression analysis and its comparison with Mallampati score and neck circumference with respect to sensitivity / specificity/ positive predictive value and negative predictive value. The study also calculated the incidence of difficult intubation among obese patients. RESULTS : Binary univariate logistic regression analysis of predictors of difficult intubation showed age greater than sixty, increased neck circumference, decreased thyromental distance, modified Mallampati test, NC/TMD ratio ≥ 5 as statistically significant variables that were associated with a difficult intubation (p ≤ 0.05). Binary multivariate logistic regression analysis showed only neck circumference (p=0.030 [odd ratio 2.519 (1.094-5.802)] and NC/TMD ratio (p <0.001 [odd ratio 23.680 (10.638-52.713)] independently predicted difficult intubation. However NC/TMD ratio had higher specificity / PPV and larger AUC on an ROC curve compared to neck circumference. The incidence of difficult intubation among obese patients was 20.8 %. INTERPRETATION AND CONCLUSIONS : Among obese patients, NC/TMD ratio can be considered as a better preoperative predictor of difficult intubation and incidence of difficult intubation among them was as high as 20.8 percent.

The Importance of Neck Circumference to Thyromental Distance Ratio (Nc/Tm Distance Ratio) as a Predictor of Difficult Intubation in Obese Patients Coming for Elective Surgery under General Anaesthesia in a Teritatry Care Hospital - A Prospective Observational Study

The Importance of Neck Circumference to Thyromental Distance Ratio (Nc/Tm Distance Ratio) as a Predictor of Difficult Intubation in Obese Patients Coming for Elective Surgery under General Anaesthesia in a Teritatry Care Hospital - A Prospective Observational Study

The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study.

The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score.The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample.The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to explain those correlations would be needed.

Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients

ABSTRACT Background Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation. Study design Prospective observational study. Materials and methods About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience. Statistical analysis used Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test. Results The incidence of difficult intubation determined by the IDS (≥5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p &lt; 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of ≥5 gives high false positive for our population. How to cite this article Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.