Document Detail

The importance of increased neck circumference to intubation difficulties in obese patients.
MedLine Citation:
PMID:  18349184     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Using the intubation difficulty scale (IDS), we sought to confirm that obese patients are more difficult to intubate than lean patients. We assessed classical bedside tests and included neck circumference. METHODS: We prospectively compared the incidence of difficult tracheal intubation in 70 obese [body mass index (BMI) > or = 30 kg/m(2)] and 61 lean patients (BMI < 30 kg/m(2)). The IDS scores, categorized as difficult intubation (IDS > 5) or not (IDS < or = 5), and the patient data, were compared between lean and obese patients. Preoperative measurements [BMI, neck circumference (at the level of the thyroid cartilage), width of mouth opening, sternomental distance, and thyromental distance], medical history of obstructive sleep apnea syndrome, and several scores (Mallampati, Wilson, El Ganzouri) were recorded. The view during direct laryngoscopy was graded, and the IDS was recorded. We then compared patients with IDS < or = 5 and > 5, concerning each item. RESULTS: The results indicate that difficult tracheal intubation is more frequent in obese than in lean patients (14.3% vs 3%; P = 0.03). In the patients with IDS > 5, thyromental distance, BMI, large neck circumference, and higher Mallampati score were the only predictors of potential intubation problems. CONCLUSION: We found that problematic intubation was associated with thyromental distance, increasing neck circumference, BMI, and a Mallampati score of > or = 3. Neck circumference should be assessed preoperatively to predict difficult intubation.
Hélène Gonzalez; Vincent Minville; Khedija Delanoue; Michel Mazerolles; Dominique Concina; Olivier Fourcade
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  106     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-19     Completed Date:  2008-04-25     Revised Date:  2009-03-12    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1132-6, table of contents     Citation Subset:  AIM; IM    
Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Toulouse, France.
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MeSH Terms
Anesthesia, General / methods
Body Mass Index
Body Size
Hydroxyzine / administration & dosage
Intubation, Intratracheal / adverse effects*
Neck / anatomy & histology*
Obesity / physiopathology*
Obesity, Morbid / physiopathology*
Point-of-Care Systems
Reg. No./Substance:
Comment In:
Anesth Analg. 2009 Mar;108(3):1051; author reply 1051-2   [PMID:  19224831 ]
Anesth Analg. 2008 Nov;107(5):1756-7; author reply 1757   [PMID:  18931245 ]

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