Document Detail


A retrospective analysis of airway management in obese patients at a teaching institution.
MedLine Citation:
PMID:  19700274     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To identify patient characteristics that influence the choice of awake fiberoptic intubation (AFI) versus intubation after general anesthesia in obese patients. DESIGN: Retrospective study. SETTING: Memorial Hermann Hospital, Houston, TX. MEASUREMENTS: Perioperative records of 283 obese patients [body mass index (BMI) >34 kg/m2] who underwent elective surgery between January 1991 and December 1999 were studied. Patients' data were divided into two groups according to method of induction and intubation: asleep direct laryngoscopy versus AFI. Patient demographics, BMI, Mallampati airway classification, history of gastroesophageal reflux disease, peptic ulcer disease, hiatal hernia, and obstructive sleep apnea syndrome were compared between the two groups. Bivariate and multivariate analyses were performed. MAIN RESULTS: AFI was performed in 12 (4.2%) obese patients, and direct laryngoscopy was performed in 271 (95.8%) obese patients. Difficult intubation was reported in 21 (7.4%) cases, and there were no reported cases of failed intubations. Bivariate analyses demonstrated that AFI patients were more likely to have a BMI > or = 60 kg/m2 (P < 0.001), Mallampati class III or IV airway (P < 0.001), and be men (P = 0.004). These three factors were also statistically significant in the multivariate logistic regression. In particular, each one kg/m(2) increase in BMI was associated with a 7% increased likelihood of AFI. Men were approximately 4 times likelier than women to have an AFI. Compared with patients with a Mallampati Class I or II airway, those with Mallampati Classes III or IV were about 26 times as likelier to have an AFI. CONCLUSIONS: Patients selected for AFI were predominantly men, with a Mallampati Class III or IV airway, and BMI > or = 60 kg/m2.
Authors:
Carin A Hagberg; Christiane Vogt-Harenkamp; Junaid Kamal
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Publication Detail:
Type:  Journal Article     Date:  2009-08-22
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  21     ISSN:  1873-4529     ISO Abbreviation:  J Clin Anesth     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-09-07     Completed Date:  2009-11-17     Revised Date:  2010-06-08    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  348-51     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, TX 77030, USA. carin.a.hagberg@uth.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, General / methods
Body Mass Index
Female
Fiber Optic Technology*
Hospitals, Teaching
Humans
Intubation, Intratracheal / methods*
Laryngoscopy / methods*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Obesity / physiopathology*
Retrospective Studies
Risk Factors
Sex Factors
Wakefulness
Comments/Corrections
Comment In:
J Clin Anesth. 2010 Jun;22(4):300-1; author reply 301-2   [PMID:  20522363 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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