Obesity

Obesity difficult intubation devices – Supraglottic airway devices in airway management of obese patients

The cookies collect this data and are reported anonymously. Perform standard laryngoscopy, attempting to identify arytenoids Lubricate bougie Insert angled end of bougie blindly under epiglottis, probing for opening Insert until clicks felt along tracheal rings If no clicks, continue insertion until resistance felt against smaller airways Retract bougie from area of resistance Advance endotracheal tube over bougie into trachea without advancing bougie Remove bougie and confirm endotracheal tube placement.

We prospectively evaluated in two obesity difficult intubation devices periods, all consecutive intubation procedures in obese patients using two multicentre databases, one containing data from 60 French medical, surgical ICU, or both collected from tointubaiton the other containing data from four anaesthesia departments, collected from to The general indications for all devices mentioned above are in situations of both predicted and unexpected difficult intubation. Park, S. Practice guidelines for management of the difficult airway. If a response was not provided, the article was excluded. The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt.

  • Google Scholar PubMed.

  • Harry J.

  • In essence, how much of the risk from intubation on ICU relative to intubation in theatres was actually related to obesity. Try out PMC Labs and tell us what you think.

  • The secondary endpoint was to compare risk factors for difficult intubation, difficult airway management techniques, and severe life-threatening complications related to intubation in obese patients admitted to ICU and OT. Newsletter The official journal of the anesthesia patient safety foundation.

Advances in Perioperative Management

Obesity is a serious disorder and may bring about many difficulties of perioperative management. Accepted 25 Apr Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Google Scholar. Download citation.

  • This article has been cited by other articles in PMC. This could be one of the reason why difficulty is encountered in intubating such patients 2.

  • The main objective of the study was to compare the incidence of difficult intubation in ICU and OT in obese patients.

  • No obvious asymmetry was detected in the funnel plots.

  • Patient characteristics and main variables in OT and ICU according to difficult intubation in obese patients.

  • Wender R, Goldman AJ. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Amathieu, L. Google Scholar. Accordingly, a direct laryngoscope DL remains the most widely obesity difficult intubation devices device for tracheal intubation [ 5 ]. Slightly longer intubation times were attained; however, significantly better intubation difficulty scale scores were also achieved with use of the Glidescope. Finally, Dr Nair mentioned that the Modified Mallampati Score performed in supine position is not reliable to predict difficulty of intubation. Table 1 The intubation difficulty score. View at: Google Scholar A.

The cookie is used to enable interoperability with urchin. We sequentially removed each study and those that included emergency tracheal intubation or parturients and then reanalysed the remaining devices. The secondary endpoints were the time to tracheal intubation TTIand the rate of successful intubation, optimization maneuvers, lowest O2 saturation during intubation, esophageal intubation, upper airway morbidity as sore throat, pharyngeal bleeding, postoperative hoarseness, swallowing difficulty and dental injury. Intubation conditions were evaluated using the Krieg scale Table 1 : K1 in the Levitan group using only laryngoscope and in Lary-Flex group using videolaryngoscope as standard laryngoscope and K2 using Levitan FPS and using the whole videolaryngoscope set. Nine studies with a total ofpatients were included in the obesity and difficult laryngoscopy group [ 723242526272829 ]. Trivedi JN.

MeSH terms

This indicates that in France, anaesthesiologists no longer consider morbidly obese as non-fasting. Furthermore, to control for obesit Type I error rate, we used Bonferroni adjustment to control the significance criterion. External link. The primary outcome was the intubation difficulty scale score IDSSecondary outcomes were theintubation time, overall success rate, number of attempts, Cormack—Lehane grade, subjective difficulty of intubation, desaturation and upper airway morbidity. Editor - I was interested to read the study of difficult intubation in obese patients in theatre compared to Intensive Care ICU.

The equipment used for intubation—in order of use—the drugs used for intubation, the use of rapid obesity difficult intubation devices induction, the Cormack and Lehane Score, and the level of difficulty of the intubation according to the ASA criteria 23 were recorded. Online First Alert. Oxford Academic. Table 2 Specific variables recorded in ICU before intubation according to difficult intubation in obese patients. Superior laryngeal nerve blocks and trans-tracheal injection of local anesthetic via the cricothyroid membrane can improve patient comfort.

  • Anesth Essays Res. Search ADS.

  • Alastair J.

  • Conflict of Interest: None declared. Gamal T.

  • De Jong, et al. Trivedi JN.

Spotlight on Technology April Select Format Select format. Futier, P. Anesthesiology ; — Difficult mask ventilation was defined as the use of one or more adjuncts to achieve successful mask ventilation. Rosenblatt[6] has provided a logical way of deciding when an awake intubation should be chosen with his Airway Approach Algorithm.

This site uses cookies. Uptake of Halothane by the Human Body. A bivariate analysis was performed to assess the relationship between severe life-threatening complications, ICU setting, and difficult intubation. Subscribe: Institutional or Individual.

INTRODUCTION

Poncelet, and L. Download citation. Rosenstock, G.

For Permissions, please email: journals. McGraw Hill; Accessed July 30, Reprinted with permission of Texas Medical Liability Trust. The cookie is set by Google Analytics.

Must the airway be managed? Editor - I was interested to read the study of difficult intubation in obese patients in theatre compared to Intensive Care ICU. Fourthly, the fact that both databases are multicentre could be a limit, because the management of intubation could differ between centres. Subscribe: Institutional or Individual. This is used to present users with ads that are relevant to them according to the user profile. Google Scholar.

The Scientific World Journal

Practice guidelines for management of the difficult airway: difficcult updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. In contrast to our results, a previous study[ 2 ] found that intubation of morbidly obese patients with GVL was slightly slower than with DL but the increased intubation time was of no clinical consequence as no patients became hypoxemic. Br J Anaesth. In ophthalmic surgeries, there is increased intraocular and intracranial tension caused due to SAD is lesser than in endotracheal tube ETT. If a response was not provided, the article was excluded.

  • Difficult tracheal intubation in obstetrics.

  • The abnormal findings should be vifficult and should be given in hand over to colleagues during intubation devices change in borderline patients who may require intubation so that necessary arrangements is made and a senior colleague's help is sought if required. This study highlights the fact that the ICU setting is an independent risk factor of severe complications, in comparison with the OT setting.

  • Girdhar, R. Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients.

  • Necessary cookies are absolutely essential for the website to function properly. Reynolds SF, Heffner J.

  • The flow chart of the study is shown in Figure 1. Contraindications : contraindication to laryngoscopy, inaccessible oral cavity.

Collins, H. The devicew included the name of the first author, year and country of publication, group situation specified BMI obesity difficult intubation devices define obesitynumber of participants, participant characteristics, study design and outcomes. The patients intubated in ICU, for many reasons, are at higher risk of difficult intubation and airway complications. The cookie is used to identify individual clients behind a shared IP address and apply security settings on a per-client basis. Gamal T.

The Anesthesia Obesity difficult intubation devices. The consequences of failure to intubate may inyubation be serious if oxygenation can be maintained by facemask or with LMA ventilation. However emergency intubation in ICU is contemplated when there's a cardiac arrest, sudden deterioration of GCS requiring airway protection or sudden cardiovascular compromise massive bleed, left ventricular failure leading to pulmonary oedema. Oral laryngoscopy with a MAC 3 blade was attempted which revealed a grade 4 view no identifiable laryngeal anatomy. This could be explained by the large use of video laryngoscopes in our four OT centres in the case of difficult intubation. Suboptimal positioning would result in a higher incidence of grade 3 and 4 Cormack-Lehane laryngoscopy views, making direct laryngoscopy and hence tracheal intubation more challenging.

Publication types

The consequences of failure to intubate may not be serious if oxygenation can be maintained by facemask or with LMA ventilation. Forgot Username? Troop is the inventor of a commercially available pre-formed positioning aid mentioned in this article. Preoperative assessment of the airways in the obese should include examination of specific predictors of difficult mask ventilation other than those for difficult intubation. There are many excellent resources addressing this topic by notable national airway educators.

Veronese, W. Primary and secondary outcomes The primary outcome was rate of difficult tracheal intubation. Benumof JL. Oxford Academic. A year-old man was scheduled for a total knee replacement.

Tracheal obesity difficult in the critically ill: a multi-centre national study of obssity and complications. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Wang, T. We wish to thank Dr Glossop, Dr Esquinas, Dr Nair and Alex Czech for their letters in response to our article, entitled "Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. However, the centre variable was taken into account in the multivariate models. In ophthalmic surgeries, there is increased intraocular and intracranial tension caused due to SAD is lesser than in endotracheal tube ETT.

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Many of these studies are from bariatric surgical populations, groups which typically consist of a larger proportion of female patients. We feel, airway examination and documentation of findings should be part of ICU practice. We read Shiga et al. IDE Used by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. We think that the priority should be to prevent difficult intubation and its complications rather than proceed to rescue therapeutics after the occurrence of complications in extreme emergency.

Part 2: intensive care and emergency departments. After entering centre variable as a random effect, the intkbation predictors for difficult intubation fodboldklub obesity Mallampati score III or IV, obstructive sleep apnoea syndrome, and reduced mobility of cervical spine Table 4. For the DL group metallic reusable blades sizes 3 and 4 were used for direct laryngoscopy. In addition, although most anaesthesiologists recommend the sniffing position and consider it to be essential for improving tracheal intubation [ 9 ], the superiority of this position has been questioned during the last decade [ 10 ]. We were surprised of the low rate of use of difficult intubation devices in ICU in this high risk context. Brock-Utne, M.

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Predicting difficult airways using the intubation difficulty scale: a study comparing obese and non-obese patients. Dhonneur et al. Behav Res Methods. Abdi, S. Nicholson, A.

Verzilli, G. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. There are several reasons for this, but perhaps an identifiable problem is the ever-increasing incidence of obesity with attendant comorbid disease processes. Awake insertion of the fibreoptic intubating LMA CTrach in three morbidly obese patients with potentially difficult airways. Br J Anaesth ;

To the Editor:—

Issue Section:. Jay B. However, the definitions used for the recorded variables, that is, difficult difficklt, risk factors for difficult intubation, or severe life-threatening complications, were the same in both databases. Intubation Strategies for Awake Intubation Caution should be always taken when administering sedative drugs since airway obstruction may occur even with minimal sedation, especially in patients with OSA.

This is particularly true for the small subset of patients with MO who have features associated with both difficult mask ventilation and difficult intubation: massive central obesity, severe OSA, high Mallampati score, and short, wide neck. Category : Past ArticlesReview. The incidence of difficult intubation and related complications in obese patients admitted to intensive care unit ICU was twice as high as patients in the operating theatre OT. Declaration of interest. A higher incidence of difficult intubation has also been suggested in patients with morbid obesity, and so some clinicians choose awake intubation as their primary strategy for airway management. The well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes.

Lack of a standard intubating position for patients with MO is a further cause of confusion. A modified version of the intubation difficulty scale mIDS was used to define easy versus difficult intubation, where a score of two or greater was defined as difficult intubation. Finally, Dr Nair mentioned that the Modified Mallampati Score performed in supine position is not reliable to predict difficulty of intubation. A complete reversal of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient in the same position with airway equipment used for intubation.

Laryngeal Mask Airway (LMA)

Cook and colleagues 58 have reported that oesophageal intubation and aspiration are important and often precursors of fodboldklub obesity ditficult. For patients with MO requiring general anesthesia the airway should be secured with either a tracheal tube or laryngeal mask airway LMA. The main message of our study is not that patients are comparable between ICU than OT, because they clearly differ. Responses to five clinical questions determine the entry point into the DAA.

  • After obtaining local research ethics board approval forthis study and written informed consent was obtained from all patients. Our primary endpoint was the time required for successful intubation for each device.

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  • In obese patients admitted to ICU, even the easy intubation can lead to life-threatening complications, difficult intubation only makes it worse Fig. Ethics declarations Ethics approval and consent to participate Not applicable.

Value of oropharyngeal Mallampati classification diffucult predicting difficult laryngoscopy among obese patients. On the whole the authors present valuable data relating to a patient obesity difficult intubation that form an increasingly common and often problematic proportion of ICU and OT patients - but does their comparison between the two very different environments really carry weight? May help minimize neck movement, ease of obtaining view of cords, may be used for rapid sequence, useful for teaching. Furthermore there is substance to the theory that intubation in the OT is more controlled than in the ICU [3], and this may also contribute to the overall reduction in complications and difficulties with intubation in obese theatre patients. A multivariate model was constructed using the intubations of obese patients in the OT where all data were available.

This obesity difficult intubation devices an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Br J Anaesth ; Furthermore, to control for the Type I error rate, we used Bonferroni adjustment to control the significance criterion. View at: Google Scholar S. Acta Anaesthesiol Scand.

Editor - I was interested to read the study of difficult intubation in obese patients devices theatre compared to Intensive Care ICU. I was wondering, therefore, if they had calculated the incidence of difficult intubations in the non-obese populations during the study period. Airway Management: Principles and Practice. The risk of pulmonary aspiration in patients after weight loss due to bariatric surgery. Davis PT Collection.

References

As the surgeon attempted a difficult tracheotomy, the patient arrested and further resuscitation efforts intubayion. The glottic view is obtained through the obesity difficult intubation devices view tube incorporated into the blade; a video system can be additionally connected. After confirmation of the adequacy of bag-mask ventilation, atracurium 0. The Lary-Flex videolaryngoscope and Levitan FPS optical stylet proved to be very good, effective, and easy to use even for anesthesiologists with limited experience using videolaryngoscopes.

OR, odds ratio; CI, confidence devices. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. This article is not intended to be a lengthy review of the difficult airway. The importance of increased neck circumference to intubation difficulties in obese patients.

Google Scholar. Article Google Scholar. The obese patients at higher risk of severe life-threatening complications were the patients admitted in ICUs with difficult intubation. A manikin-based study.

No evidence of publication bias was evident by visual inspection of the funnel plot Fig. The cookie is used to allow the paid version of the plugin to connect entries by the same user and is used eifficult some obesity difficult intubation devices features like the Form Abandonment addon. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Laryngoscopy may be difficult in obese patients because of elevated chest diameter giving limited space for the laryngoscope positioning, limited neck mobility, and increased amount of fat tissue in the upper airway, including a larger tongue [ 56 ]. Therefore, the risk of difficult intubation was almost twofold higher in ICU than in OT in both obese and non obese populations. Search ADS. Future analyses should explore the association of BMI and difficult airway.

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The use of videolaryngoscopes is recommended for morbidly obese patients. Crit Care obesity difficult intubation devices, doi: The authors declare that there is no conflict of interests regarding the publication of this paper. Brodsky, J. The cookie is set by Google Analytics.

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Declaration of interest. The difficult airway was defined by an ASA task force as the clinical situation in which a conventionally trained anesthesiologist experiences problems with face mask ventilation of the upper airway, tracheal intubation, or both. This might be an explanation for the severe complications in ICU. Therefore, the risk of difficult intubation was almost twofold higher in ICU than in OT in both obese and non obese populations. May help minimize neck movement, ease of obtaining view of cords, may be used for rapid sequence, useful for teaching.

Based on both our clinical experience at an active bariatric surgical center and on the few prospective studies that have addressed this issue, we question the validity of the general statement that obese patients are three times more difficult to intubate than their slimmer counterparts. Sign In. Continuing Education. Conclusion: Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. The well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes.

Then, we excluded studies devices the initial review of deviecs title and after the abstract was reviewed due to they are not endotracheal intubation, letters, reviews, cross-sectional studies and case reports. However, subgroup analysis showed no trend of a higher association of obesity with a risk of DI compared with non-obesity in cohort studies and no association with an increased risk of difficult laryngoscopy in the sniffing position. Please see Caplan, et al. The use of videolaryngoscopes in morbidly obese patients not only improves glottic view but also makes intubation efforts easier and less traumatic [ 1415 ].

Atchabahian A, Gupta R. The primary jntubation was the incidence of difficult intubation. After entering centre variable as a random effect, the main predictors of difficult intubation were: Mallampati score III or IV, obstructive sleep apnoea syndrome, reduced mobility of cervical spine, limited mouth opening, coma, and severe hypoxaemia Table 3. Chapter In a classic rapid sequence induction, no mask ventilation is allowed for 1 min once the sequence has been started.

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Crit Caredoi: Gonzalez, V. We present obesity difficult intubation devices results of a prospective study where the incidence of difficult intubation, the risk factors of difficult intubation, the difficult airway management techniques, and the complications related to intubation were compared between two cohorts of obese patients admitted to ICU and OT and undergoing intubation. The cookies collect this data and are reported anonymously. Table 5 Definitive airway management techniques for difficult intubation in operative theatre and ICU according to difficult intubation in obese patients.

Eur J Anaesthesiol. However you may visit Cookie Settings to provide a controlled consent. Try out PMC Labs and tell us what you think. Maciejewski, H.

Practice guidelines for management of the difficult infubation. 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. To the best of our knowledge, this is the first meta-analysis focusing on evaluating the association between obesity with risk of DI in recent decades. Comparison of the Glidescope and Airtraq optical laryngoscopes in patients undergoing direct microlaryngoscopy. Advertisement advertisement. Additionally, there is further evidence of the differences between the two groups of patients in the method of intubation utilised.

Figure 2. These data were analyzed by using SPSS Evaluations of the intubation conditions are presented in Figures 56and 7. Oxford Academic.

If awake intubation is mandatory, it may be performed with fibrobronchoscope after providing an adequate topical anesthesia and sedation with short-acting drugs, such as remifentanil. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units Br. Abstract Purpose: To determine the influence of morbid obesity on the incidence of difficult mask ventilation and difficult intubation. Shiga et al. It does not correspond to any user ID in the web application and does not store any personally identifiable information.

De JongA. This simple test addresses D3 and D6. Abstract Background. Verzilli, G. Davis PT Collection.

References

The airway is therefore obesity difficult intubation devices isolated and easier to work with. In difcicult surgeries, there is increased intraocular and intracranial tension caused due to SAD is lesser than in endotracheal tube ETT. The discussion focused on whether the data conformed to the included criterion. If plan A is not achieving the desired result, activate plan B, or C early.

Difficult laryngoscopy and difficulty in intubation are the common problems that an anesthesiologist will face when an obese patient comes to the emergency department, ICU or for surgery. But opting out of some of these cookies may have an effect on your browsing experience. Success of tracheal intubation was analyzed using the X 2 -test. The cookie is updated every time data is sent to Google Analytics. Benumof JL.

Can J Anaesth. This site uses cookies to provide, maintain and improve your experience. Username Error: Please intubatin User Name. To our knowledge, it was proved a few years ago to be strongly reliable [2]. But opting out of some of these cookies may have an effect on your browsing experience.

Background

The authors of the retrieved studies were contacted by S. Maassen, B. Intubation devices cookies is set by Youtube and is used to track the views of embedded videos. SADs are better option as they help in reduction of pressor response and provide better hemodynamic stability compared to laryngoscopy and intubation.

A multivariate model was constructed using the intubations of obese difficcult in the ICU where all data were available. Reprints and Permissions. The importance of increased neck circumference to intubation difficulties in obese patients. Airway management of the critically ill patient: rapid-sequence intubation. There are clear differences in airway management techniques between departments and hospitals and we need evidence to see which ones are safest either as a whole or in higher risk populations. Source of Support: Nil.

  • View video laryngoscope in patients with difficult airways.

  • Sign in via Shibboleth. This ongoing concern in anesthesiology is being revisited in light of the personal observation that as the prevalence of obesity increases, standard oral intubation is becoming more difficult.

  • Nasotracheal AirTraq intubation, which we used, is modified: it has no channel for the tube.

We feel that the work addresses an important and increasingly problematic area of current anaesthetic and Obesity difficult intubation devices practice, and contributes to the current evidence base in the area. The authors report a significantly greater usage of airway adjuncts and definitive techniques in the OT than in the ICU. Purpose: To determine the influence of morbid obesity on the incidence of difficult mask ventilation and difficult intubation. Exclusion criteria were pregnancy or being under 18 yr of age. Airway Management: Principles and Practice. Can J Anaesth. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation?

Delanoue, M. The authors of the retrieved studies were contacted by S. It is also important to note that LMA causes lesser incidence of laryngospasm, postoperative sore-throat and coughing. The authors thank all participating staff of all the centres. Journal overview.

J Anesthdoi: Philadelphia: Churchill Livingstone Elsevier; Role of SADs have not been observed in different surgeries in detail. Anaesthesia ; View author publications.

Figure 5. Devices patients were anesthetized following our institution protocols: induction of anesthesia with propofol 2. As mentioned earlier, I have observed a trend of an increase in the overall number of difficult airway patients. Maassen, R. The following summary is based on an actual closed claim case.

Reynolds SF, Heffner J. Other strategies may include availability of alternative airway management devices, including fodboldklub obesity video laryngoscopes that significantly improve the visualization of the larynx and thereby facilitate intubation. This cookie is used to a profile based on user's interest and display personalized ads to the users. However, hypoxemia and cardiovascular collapse were considered as complications only if there were not present before intubation. See Figure

The cookie is used to identify individual clients behind a shared IP address and apply security settings on a per-client basis. In the current study, there were fold more intubation devices resulting from airway management in ICU than OT in obese patients. The headline findings of the study were that difficult intubation in obese patients is twice as likely to be seen in the ICU rather than the OT, and that severe life threatening complications relating to intubation were up to 20 times more frequent in ICU compared to the OT.

Contraindications : devices to laryngoscopy, inaccessible oral cavity. The consequences of failure to intubate may not be serious if oxygenation can be maintained by facemask or with LMA ventilation. De Jong, N. Intybation and cardiovascular collapse were the two most common severe complications seen post intubation in obese ICU patients but with the above data in mind is this really a complication, or just a manifestation of the worsening pathophysiology already frequently present in this patient group? Troop is the inventor of a commercially available pre-formed positioning aid mentioned in this article. We demonstrated that elevating the upper body and head of morbidly obese patients to align their sternum and ear in a horizontal line head-elevated laryngoscopy position results in significant improvement in laryngoscopic view.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management obesith the Difficult Airway. A modified version of the intubation difficulty scale mIDS was used to define easy versus difficult intubation, where a score of two or greater was defined as difficult intubation. Noninvasive techniques, such as nebulization, may result in administration of large doses of local anesthetic with unpredictable effects as solution is lost to the atmosphere. Jaber S.

A pre-cut foam positioner designed to quickly achieve the HELP position is commercially available. Inthe ASA has defined difficult endotracheal intubation as 3 attempts at endotracheal intubation when an average laryngoscope is used or when endotracheal intubation takes 10 min or more [ 11 ]. J Emerg Trauma Shock. In addition to obesity concerns, his medical history included hypertension, hypercholesterolemia, GERD, type II diabetes diet controlledand possible sleep apnea.

The incidence of obesity in the adult population is growing. Figure 2 presents the risk of severe life-threatening complications in obese patients according to the location of intubation and difficult intubation. Sign In or Create an Account. The cookies collect this data and are reported anonymously.

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All patients were anesthetized following our institution protocols: induction of anesthesia with propofol intubation devices. Edited by Miller RD. Second, we only explored difficult tracheal intubation by direct laryngoscopy and not by difficult airway, therefore lacking facemask data. Director, University Hospital of Montpellier. However, the centre variable was taken into account in the multivariate models. J Emerg Trauma Shock.

However, whilst obesity provides clinical challenges including potential difficult airways, the authors of this study 2 difficylt that the association of BMI with difficult intubation per se remains controversial. This might be an explanation for the severe complications in ICU. Open in new tab. Close mobile search navigation Article navigation. On the whole the authors present valuable data relating to a patient group that form an increasingly common and often problematic proportion of ICU and OT patients - but does their comparison between the two very different environments really carry weight?

Gonzalez, V. No complications of intubation were observed. However, this does not modify the main message of this study, i. Cormack RS, Lehane J.

  • Brodsky, H. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units.

  • Invasive procedure requiring multiple items Time consuming. Davis AT Collection.

  • In addition, the Mallampati score was assessed in recumbent dfificult in obesity difficult intubation devices ICU cohort. The Intubation Difficulty Scale IDS score, an objective scoring system that consists of numerical expressions of parameters and has been validated in many studies, was proposed to assess intubation difficulty in a standardized manner [ 13 ].

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  • Although transitory hypertension and tachycardia are intubation devices dificult little clinical consequence in healthy individuals, they may be a matter of concern in patients with known, or at risk of, cardiovascular disease such as obese patients [ 28 ]. A comparison of the upper lip bite test a simple new technique with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study.

More related articles. Dear Editor: We read with great interest the work of De Obesitg and colleagues [1] relating to difficult intubation in the obese patients in the intensive care unit ICU and operating theatre OT and congratulate the authors on the scope of their study. Astrup, and J. The ease of intubation visual analog scale demonstrated that operators found the GVL and the CT significantly easier for intubation compared to DL. References 1.

Atkins RF. In obese patients, the incidence of difficult intubation was twice more frequent in ICU than in the OT and severe life-threatening complications related to intubation occurred fold more oebsity in ICU. However, when there is a significant risk of aspiration or when there is any doubt regarding ability to intubate or to mask ventilate, an awake intubation is better. Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients. In addition to obesity concerns, his medical history included hypertension, hypercholesterolemia, GERD, type II diabetes diet controlledand possible sleep apnea. The risk of pulmonary aspiration in patients after weight loss due to bariatric surgery.

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