Airway management in the obese patient: a literature review
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i1e-199864Keywords:
Obesity, Airway management, Intratracheal intubationAbstract
Introduction: Airway management in obese patients is a concern for anesthesiologists. This procedure is more difficult in this population due to anatomical and physiological changes caused by excess fat. Obese patients have pulmonary alterations that may lead to faster desaturation, which makes this group more susceptible to complications during tracheal intubation. Objective: To understand which factors are responsible for the higher incidence of difficult airway in obese patients. Methods: A survey on the DeCS platform, followed by PubMed and SciELO was carried out to identify articles related to the topic, including Randomized Clinical Trials, Systematic Reviews, Meta-Analysis and Books and Documents. A total of 20 articles in Portuguese, English and Spanish were selected. Results: Of the analyzed studies, three identified Mallampati III/IV, reduced mobility of cervical spine and limited mouth opening as risk factors for difficult airway. One study identified neck circumference as an associated factor, while the others stated that there is no relationship between neck circumference and difficult airway. Conclusion: There was no consensus in the literature regarding the risk factors for difficult airway. It is necessary to develop retrospective studies that analyze patients with difficult airway and complications, determining which factors were present and affected the procedure.
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Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica (ABESO). Diretrizes brasileiras de obesidade. São Paulo: Abeso; 2016. Disponível em: https://abeso.org.br/wp-content/uploads/2019/12/Diretrizes-Download-Diretrizes-Brasileiras-de-Obesidade-2016.pdf
Ferreira APDS, Szwarcwald CL, Damacena GN. Prevalência e fatores associados da obesidade na população brasileira: estudo com dados aferidos da Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol. 2019;22. doi: https://doi.org/10.1590/1980-549720190024
Brodsky JB. Recent advances in anesthesia of the obese patient. F1000Research. 2018;7. doi: 10.12688/f1000research.15093.1
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by thge american society of anesthesiologists task force on management of the difficult airway. Anesthesiology. 118(2):251-70. doi: 10.1097/ALN.0b013e31827773b2
De Jong A, Molinari N, Pouzeratte Y, Verzilli D, Chanques G, Jung B, Futier E, Perrigault PF, Colson P, Capdevila X, Jaber S. Difficult intubation in obese patients: incidence, risk factors, and complications in the op-erating theatre and in intensive care units. Brit J Anaesth. 2015;114(2):297-306. doi: 10.1093/bja/aeu373
Saasouh W, Laffey K, Turan A, Avitsian R, Zura A, You J, Zimmerman NM, Szarpak L, Sessler DI, Ruetzler K. Degree of obesity is not associated with more than one intubation attempt: a large centre experience. Brit J Anaesth. 2018 1;120(5):1110-6. doi: 10.1016/j.bja.2018.01.019
Brodsky JB, Lemmens HJM, Brock‐Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analgesia. 2002;94:732-6. doi: 10.1097/00000539-200203000-00047
Melo LC, Silva MAM, Calles ACN. Obesidade e função pulmonar: uma revisão sistemática. Einstein (São Paulo). 2014;12(1):120-125. doi: 10.1590/S1679-45082014RW2691
Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anesth. 2012;59:974-996. doi: 10.1007/s12630-012-9760-2
Wang HX, Wan L, Tian M, Xue FS. A safe strategy for anesthesia induction and airway management in morbidly obese patients. Chinese Med J. 2019;132(14):1747. doi: https://doi.org/10.1097/CM9.0000000000000320
Magalhães E, Marques FO, Govêia CS, Ladeira LC, Lagares J. Uso de preditores clínicos simples no diagnóstico pré-operatório de dificuldade de intubação endotraqueal em pacientes portadores de obesidade. Rev Bras Anestesiol. 2013;63(3):262-6. https://doi.org/10.1590/S0034-70942013000300006
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. https://doi/10.1186/s13643-021-01626-4
Sheff SR, May MC, Carlisle SE, Kallies KJ, Mathiason MA, Kothari SN. Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter? Surg Obes Relat Dis. 2013;9(3):344-9. doi: 10.1016/j.soard.2012.02.004
Cattano D, Katsiampoura A, Corso RM, Killoran PV, Cai C, Hagberg CA. Predictive factores for difficult mask ventilation in the obese surgical population. F1000 Res. 2014;3:239. https://doi.org/10.12688/f1000research.5471.1
Alanís Uribe K, Guerrero Morales F, Gómez Cruz JR. Relación entre la circunferencia del cuello y vía aérea difícil en pacientes obesos. Anest Méx. 2017;29(2):18-27. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-87712017000200018&lng=es.
Aldenkortt M, Lysakowski C, Elia N, et al. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Br J Anaesth. 2012;109 (4):493-502. doi: 10.1093/bja/aes338
Toshniwal G, McKelvey GM, Wang H. STOP-Bang and prediction of difficult airway in obese patients. J Clin Anesth. 2014;26:360-367. doi: 10.1016/j.jclinane.2014.01.010
Uribe AA, Zvara DA, Puente EG, et al. BMI as a predictor for potential difficult tracheal intubation in males. Front Med. 2015;2:38. doi: 10.3389/fmed.2015.00038
Fonseca LBDM, Silveira EA, Lima NM, Rabahi MF. Tradução e adaptação transcultural do questio-nário STOP-Bang para a língua portuguesa falada no Brasil. J Bras Pneumol. 2016;42:266-272. http://dx.doi.org/10.1590/S1806-37562015000000243
Hagberg CA, Gabel JC, Connis RT. Difficult Airway Society 2015 guidelines for the management of unanticipated difficult intubation in adults: not just another algotithm. Brit J Anaesth. 2015;115(6):812-814. doi: 10.1093/bja/aev404
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society intubation guidelines working group, Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults, BJA: Brit J Anaesth. 2015;115(6):827-848. doi: 10.1093/bja/aev371
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