Encinas PCM, Portela OJM, Ley MLA

Language: Spanish
References: 20
Page: 211-217
PDF size: 208.88 Kb.

ABSTRACT

The management of the airway in obese patients is a challenge for the anesthesiologist. Objective: Analyze variables associated with obese patients with difficult intubation. Material and methods: 62 surgical patients were included obese adults, 8 airway variables were evaluated: Mallampati, tiromentoniana distance, esternomentoniana distance (DEM), oral opening, mandibular protrusion, extension of atlanto-occipital articulation, cervical diameter and obstructive sleep apnea syndrome; in the operating room after the anesthetic induction, orotracheal intubation was performed, classifying the difficulty to intubate by the number of laryngoscopes taking 2 or more attempts as difficult intubation. Results: 17 (27.4%) patients with difficult airway; 10 (16.1%) of them with obesity grade I, the variable associated to airway difficult was the DEM, presented p = 0.01, RR 0.2 (CI_95% 0.07-0.7), sensitivity of 41.1, specificity of 91.1, a positive predictive value (VPP) of 63.6 and a negative predictive value (VPN) of 80.3. Conclusions: The degree of obesity and BMI is not directly proportional to a difficult airway, but the D-E-M is the most useful test preoperative at the time of evaluating an airway in obese patients. Those taking an important part in the anesthesiologist skill and experience.

REFERENCES

1. Mace SE. Challenges and advances in intubation: airway evaluation and controversies with intubation. Emerg Med Clin North Am. 2008; 26 (4): 977-1000, ix.

2. Escobar J. ¿Cuánto podemos predecir la vía aérea difícil? Rev Chil Anest. 2009; 38: 84-90.

3. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. 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. 2003; 98 (5): 1269-1277.

4. Brunet L. Vía aérea difícil en obesidad mórbida. Rev Chil Anest. 2010; 39: 110-115.

5. Vargas-Escalona K, García-Farell C, Ramírez-Paesano C. Airtraq® versus fibroscopio flexible para intubación en obesos mórbidos con predictores de vía aérea difícil en cirugía bariátrica. Rev Mex Anest. 2015; 38 (1): 5-14.

6. Myatt J, Haire K. Airway management in obese patients Focus on: Bariatric. Curr Anaesth Crit Care. 2010; 21: 9-15.

7. Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesth. 2001; 13 (2): 144-156.

8. Orozco-Díaz E, Álvarez-Ríos JJ, Arceo-Díaz JL, Ornelas-Aguirre JM. Predicción de intubación difícil mediante escalas de valoración de la vía aérea. Cir Cir. 2010; 78 (5): 393-399.

9. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth. 1994; 73 (2): 149-153.

10. Villamil-Cendales AP. Manejo anestésico del paciente obeso. Rev Colomb Anestesiol. 2006, 34 (1): 41-48.

11. Kristensen MS. Airway management and morbid obesity. Eur J Anaesthesiol. 2010; 27 (11): 923-927.

12. El Solh AA. Airway management in the obese patient. Clin Chest Med. 2009; 30 (3): 555-568, ix.

13. Lundstrøm LH, Møller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology. 2009; 110 (2): 266-274.

14. Covarrubias-Gómez A, Guevara-López U, Haro-Valencia R, Alvarado-Suárez M. El síndrome de apnea obstructiva del sueño y su importancia en la medicina perioperatoria. Rev Med Inst Mex Seguro Soc. 2007; 45 (4): 371-380.

15. Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth. 1998; 80 (5): 606-611.

16. Buckley FP, Robinson NB, Simonowitz DA, Dellinger EP. Anaesthesia in the morbidly obese. A comparison of anaesthetic and analgesic regimens for upper abdominal surgery. Anaesthesia. 1983; 38 (9): 840-851.

17. Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002; 94 (3): 732-736.

18. Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003; 97 (2): 595-600.

19. Gempeler-Fritz E, Díaz L, Sarmiento L. Airway management in bariatric surgery patients at Hospital Universitario de San Ignacio, Bogotá (Colombia). Rev Colomb Anestesiol. 2012; 40 (2): 119-123.

20. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005; 103 (2): 429-437.