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Multivariate Analysis of the Failure Risk of First Tracheal Intubation Attempt in a Population of Patients Scheduled for Bariatric Surgery

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Abstract

Background

Airway management during the administration of anesthesia to patients undergoing bariatric surgery is challenging. The goal is to avoid multiple intubation attempts because the risk of complications increases with the number of attempts. The objective of this study was to determine the failed first intubation attempt rate, as well as variables associated with this failure, in patients undergoing bariatric surgery.

Methods

We enrolled patients scheduled for bariatric surgery in this prospective, observational, single-center study. We determined predictive criteria for difficult intubation at the preoperative anesthesia consultation. All patients were evaluated for obstructive sleep apnea by polygraphy. The primary study endpoint was a failed first intubation attempt.

Results

We enrolled 519 patients between December 2012 and January 2015. The cohort consisted of 425 women (82%), with a median (interquartile range [IQR]) age of 39 (30–50) years and a body mass index of 42 (39–46) kg/m2. The first intubation attempt failed in 60 patients, with an incidence rate of 11.5% (95% confidence interval [CI], 8.8–14.2%). We included nine variables in the final multivariate model. Two variables were associated with failed first intubation attempt: male sex (odds ratio [OR] [95% CI], 6.9% [2.5–18.7%]) and Mallampati score 3–4 (OR [95% CI], 2.2% [1.0–4.7%]).

Conclusions

In this morbidly obese population, the first intubation attempt failed in 11.5% of patients, and the risk factors for failure were male sex and a high Mallampati score.

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Author information

Authors and Affiliations

  1. Emergency Department – SAMU, Pellegrin Hospital, Bordeaux University Hospital, CHU de Bordeaux, F-33076, Bordeaux Cedex, France

    Michel Galinski & Cédric Gil-Jardiné

  2. Inserm, ISPED, Bordeaux Population Health Research Center INSERM U1219-“Injury Epidemiology Transport Occupation” Team, Bordeaux University, Bordeaux, France

    Michel Galinski

  3. Department of Anesthesiology and Critical Care Medicine, Cochin University Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Paris, France

    Marine Chouteau & Christophe Baillard

  4. Department of Anesthesiology, Jean Verdier University Hospital, Paris 13 University, Assistance Publique-Hôpitaux de Paris, Bondy, Paris, France

    Gessica Lunghi, Marianne Vinurel, Béatrice Blazy, Mouni Cher, Bruno Alouane, Hélène Bento & Jean-Louis Germain

  5. Department of Digestive and Metabolic Surgery, Jean Verdier University Hospital, Paris 13 University, Assistance Publique-Hôpitaux de Paris, Bondy, Paris, France

    Christophe Barrat

  6. Department of Anesthesiology and Critical Care Medicine, Princesse Grace Hospital, 98010, Monaco, Monaco

    Jean Catineau

Authors
  1. Michel Galinski
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  2. Marine Chouteau
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Corresponding author

Correspondence to Michel Galinski.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Key Points

• The failure of first tracheal intubation attempt is associated with high risk of complications.

• We measured the rate of failure of the first tracheal intubation attempt in bariatric surgery and associated risk factors.

• This rate was 11.5% and risk factors were male sex and Mallampati score 3–4.

• Particular attention should be done before intubation with these patients to reduce the risk of failure of the first intubation attempt.

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Galinski, M., Chouteau, M., Lunghi, G. et al. Multivariate Analysis of the Failure Risk of First Tracheal Intubation Attempt in a Population of Patients Scheduled for Bariatric Surgery. OBES SURG 31, 4392–4398 (2021). https://doi.org/10.1007/s11695-021-05586-5

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  • DOI: https://doi.org/10.1007/s11695-021-05586-5

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