Magalhães Edno, Oliveira Marques Felipe, Sousa Govêia Cátia, Araújo Ladeira Luis Cláudio, Lagares Jader
Anesthesiology Center, Universidade de Brasília, Hospital Universitário de Brasília, Brasília, DF, Brazil.
Braz J Anesthesiol. 2013 May-Jun;63(3):262-6. doi: 10.1016/S0034-7094(13)70228-9.
Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors.
Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis.
Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy.
The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy.
尽管肥胖患者和非肥胖患者中困难喉镜检查的发生率相似，但肥胖个体中困难插管的报道更多。术前诊断和预测困难插管的替代方法可能有助于减少肥胖患者的麻醉并发症。本研究的目的是确定肥胖患者困难气道诊断的预测因素，并将其与麻醉前评估的临床方法及多导睡眠图相关联。我们还比较了肥胖患者和非肥胖患者中困难面罩通气和困难喉镜检查的发生率，确定最常见的预测因素。
进行观察性、前瞻性和比较性研究，纳入88例接受全身麻醉的成年患者。在术前阶段，我们评估了一份关于阻塞性睡眠呼吸暂停综合征（OSAS）临床预测因素和解剖学参数的问卷。在麻醉期间，我们评估了困难面罩通气和喉镜检查情况。采用描述性统计和相关性检验进行分析。
患者被分为两组：肥胖组（n = 43）和非肥胖组（n = 45）。肥胖组的身体状况、打鼾患病率、高血压、糖尿病、颈围和马兰帕蒂指数更高。肥胖患者困难面罩通气和喉镜检查的发生率更高。两组中解剖学或临床变量与困难面罩通气之间均无相关性。在肥胖患者中，OSAS的诊断与困难喉镜检查显示出强烈相关性。
OSA的临床和多导睡眠图诊断在术前困难喉镜检查诊断中被证明是有用的。肥胖患者更容易出现困难面罩通气和喉镜检查。
