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Do All Morbidly Obese Patients Have a “Difficult” Airway?

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Controversies in the Anesthetic Management of the Obese Surgical Patient

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Abstract

There has long been held an acceptance that morbidly obese patients present problems with airway management. This chapter will highlight arguments that both agree with and challenge this assumption. Recent studies question the correlation between elevated BMI and difficult direct laryngoscopy, probably because excess adipose tissue has a variable distribution among MO patients. The reader will be able to identify a subset of MO patients where difficult airway management is indeed expected. In such patients, maximizing oxygenation is of primary importance. This chapter will therefore also highlight best practice in terms of preoxygenation and recruitment maneuvers which minimize atelectasis. Suggested alternatives to direct laryngoscopy that achieve rapid intubation will be recommended.

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References

  1. Peterson GN, Domino KB, Caplan RA, Posner KL et al (2005) Management of the difficult airway: a closed claims analysis. Anesthesiology 103:33–39

    Article  PubMed  Google Scholar 

  2. Cook TM, Woodall N, Frerk C, Fourth National Audit Project (2011) Major complications of airway management in the UK: results of the Fourth National Audit project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 106:617–631

    Article  PubMed  CAS  Google Scholar 

  3. Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit Project (2011) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 106:632–642

    Article  PubMed  CAS  Google Scholar 

  4. American Society of Anesthesiologists Task Force on Management of the Difficult Airway (2003) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 98:1269–1277

    Google Scholar 

  5. Kheterpal S, Han R, Tremper KK et al (2006) Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 105:885–891

    Article  PubMed  Google Scholar 

  6. Kheterpal S, Martin L, Shanks AM et al (2009) Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology 110:891–897

    Article  PubMed  Google Scholar 

  7. Hagberg CA, Vogt-Harenkamp C, Kamal J (2009) A retrospective analysis of airway management in obese patients at a teaching institution. J Clin Anesth 21:348–351

    Article  PubMed  Google Scholar 

  8. Tagaito Y, Isono S, Remmers JE, Tanaka A et al (2007) Lung volume and collapsibility of the passive pharynx in patients with sleep-disordered breathing. J Appl Physiol 103:1379–1385

    Article  PubMed  Google Scholar 

  9. Juvin P, Lavaut E, Dupont H, Lefevre P et al (2003) Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 97:595–600

    Article  PubMed  Google Scholar 

  10. Brodsky JB, Lemmens HJ, Brock-Utne JG et al (2002) Morbid obesity and tracheal intubation. Anesth Analg 94:732–736

    Article  PubMed  Google Scholar 

  11. Isono S (2008) One hand, two hands, or no hands for maximizing airway maneuvers? Anesthesiology 109:576–577

    Article  PubMed  Google Scholar 

  12. Shiga T, Wajima Z, Inoue T et al (2005) Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 103:429–437

    Article  PubMed  Google Scholar 

  13. Neligan PJ, Porter S, Max B, Malhotra G et al (2009) Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesth Analg 109:1182–1186

    Article  PubMed  Google Scholar 

  14. Mashour GA, Kheterpal S, Vanaharam V et al (2008) The extended Mallampati score and a diagnosis of diabetes mellitus are predictors of difficult laryngoscopy in the morbidly obese. Anesth Analg 107:1919–1923

    Article  PubMed  Google Scholar 

  15. Collins JS, Lemmens HJ, Brodsky JB et al (2004) Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg 14:1171–1175

    Article  PubMed  Google Scholar 

  16. Gonzalez H, Minville V, Delanoue K et al (2008) The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 106:1132–1136

    Article  PubMed  Google Scholar 

  17. Ezri T, Gewurtz G, Sessler DI et al (2003) Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia 58:1111–1114

    Article  PubMed  CAS  Google Scholar 

  18. Keller C, Brimacombe J, Kleinsasser A et al (2002) The Laryngeal Mask Airway ProSeal™ as a temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation. Anesth Analg 94:737–740

    Article  PubMed  Google Scholar 

  19. Ndoko SK, Amathieu R, Tual L et al (2008) Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. Br J Anaesth 100:263–268

    Article  PubMed  CAS  Google Scholar 

  20. Doyle DJ, Zura A, Ramachandran M et al (2007) Airway management in a 980-lb patient: use of the Aintree intubation catheter. J Clin Anesth 19:367–369

    Article  PubMed  Google Scholar 

  21. Dhonneur G, Ndoko S, Amathieu R et al (2007) Tracheal intubation using the Airtraq in morbid obese patients undergoing emergency cesarean delivery. Anesthesiology 106:629–630

    Article  PubMed  Google Scholar 

  22. Sun DA, Warriner CB, Parsons DG et al (2005) The GlideScope Video Laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 94:381–384

    Article  PubMed  CAS  Google Scholar 

  23. Suzuki A, Terao M, Aizawa K et al (2009) Pentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position. J Anesth 23:162–163

    Article  PubMed  Google Scholar 

  24. Jense HG, Dubin SA, Silverstein PI et al (1991) Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg 72:89–93

    Article  PubMed  CAS  Google Scholar 

  25. Gambee AM, Hertzka RE, Fisher DM (1987) Preoxygenation techniques: comparison of three minutes and four breaths. Anesth Analg 66:468–470

    Article  PubMed  CAS  Google Scholar 

  26. Dixon BJ, Dixon JB, Carden JR et al (2005) Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 102:1110–1115

    Article  PubMed  Google Scholar 

  27. Altermatt FR, Munoz HR, Delfino AE et al (2005) Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. Br J Anaesth 95:706–709

    Article  PubMed  CAS  Google Scholar 

  28. Baraka AS, Taha SK, Siddik-Sayyid SM et al (2007) Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia 62:769–773

    Article  PubMed  CAS  Google Scholar 

  29. Coussa M, Proietti S, Schnyder P et al (2004) Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 98:1491–1495

    Article  PubMed  Google Scholar 

  30. Gander S, Frascarolo P, Suter M et al (2005) Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg 100:580–584

    Article  PubMed  Google Scholar 

  31. Reinius H, Jonsson L, Gustafsson S et al (2009) Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology 111:979–987

    Article  PubMed  Google Scholar 

  32. Talab HF, Zabani IA, Abdelrahman HS et al (2009) Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. Anesth Analg 109:1511–1516

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesia, Anesthesia Stanford University, Stanford, CA, USA

    Jeremy S. Collins

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  1. Jeremy S. Collins
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Correspondence to Jeremy S. Collins .

Editor information

Editors and Affiliations

  1. Santa Maria degli Angeli Medical Centre, Pordenone, Italy

    Yigal Leykin

  2. Stanford University School of Medicine, Stanford, 94305, California, USA

    Jay B. Brodsky

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Collins, J.S. (2013). Do All Morbidly Obese Patients Have a “Difficult” Airway?. In: Leykin, Y., Brodsky, J. (eds) Controversies in the Anesthetic Management of the Obese Surgical Patient. Springer, Milano. https://doi.org/10.1007/978-88-470-2634-6_14

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  • DOI: https://doi.org/10.1007/978-88-470-2634-6_14

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2633-9

  • Online ISBN: 978-88-470-2634-6

  • eBook Packages: MedicineMedicine (R0)

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