Canadian Journal of Anaesthesia

, Volume 50, Issue 2, pp 179–183

Increased body mass indexper se is not a predictor of difficult laryngoscopy

  • Tiberiu Ezri
  • Beniamin Medalion
  • Marian Weisenberg
  • Peter Szmuk
  • R. David Warters
  • Ilan Charuzi
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

We investigated the association between morbid obesity and difficult laryngoscopy (DL).

Methods

In a prospective, controlled study we evaluated the impact of different variables on the prediction of DL in 200 morbidly obese (study group-SG), and 1,272 non-obese (control group-CG) patients undergoing elective surgery. Variables assessed included age, sex, body mass index (BMI), protruding, loose, and missing upper teeth, thyro-mental distance, temporo-mandibular joint (TMJ) function, neck extension, and Mallampati class. A Cormack grade III or IV was considered DL.

Results

The SG patients were younger (P < 0.000), there were more females in the SG (P < 0.000) and more in the SG had teeth problems (P = 0.026). More patients in the SG (10%vs 1%), had obstructive sleep apnea (P < 0.001) with 90% of them in the SG having a grade III laryngoscopy. High BMI did not affect the laryngoscopy difficulty (P = 0.56). Multivariable regression analysis revealed that morbid obesity, increased age, male sex, pathology of TMJ, and higher Mallampati class, were independent predictors of DL. When interaction between the predictors and the group was added to the multivariable model, the SG was no longer a predictor by itself, rather its association with abnormal upper teeth turned to be significant for prediction of DL.

Conclusions

Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL. The magnitude of BMI had no influence on difficulty with laryngoscopy.

Un indice de masse corporelle élevé n’est pas, en soi, un prédicteur de laryngoscopie difficile

Résumé

Objectif

Nous avons examiné le lien entre l’obésité morbide et la laryngoscopie difficile (LD).

Méthode

Dans une étude prospective et contrôlée, nous avons évalué l’impact de différentes variables sur la prédiction de LD chez 200 patients présentant une obésité morbide (groupe expérimentai — GE) et 1272 patients non obèses (groupe témoin — GT) devant subir une intervention chirurgicale réglée. Les variables évaluées ont été: l’âge, le sexe, l’indice de masse corporelle (IMC), la protrusion, la mobilité et l’absence de dents supérieures, la distance thyromentonnière, la compétence de l’articulation temporo-mandibulaire (ATM), l’extension du cou et la classification de Mallampati. Une cote III ou IV de Cormack a été considérée comme une LD.

Résultats

Les patients du GE étaient plus jeunes (P < 0,000), comprenaient plus de femmes (P < 0.000) et présentaient plus de problèmes dentaires (P = 0,026). Un plus grand nombre de patients du GE (10 % vs 1%) avaient une apnée du sommeil d’origine obstructive (P < 0,001) dont 90 % présentaient une laryngoscopie de classe III. Un IMC élevé n’a pas eu d’influence sur la laryngoscopie difficile (P = 0,56). Une analyse de régression multivariable a révélé que l’obésité morbide, l’âge avancé, le sexe mâle, une pathologie de l’ATM et une cote de Mallampati plus élevée ont été des prédicteurs indépendants de LD. Si on ajoute l’interaction entre les prédicteurs et le groupe au modèle multivariable, le GE n’est pius un prédicteur en lui-même, quoique son association avec une dentition supérieure anormale apparaisse significative pour prédire une LD.

Conclusion

Le vieillissement, le sexe masculin, une pathologie de l’ATM, une ciasse 3 ou 4 de Mallampati, des antécédents d’apnée du sommeil d’origine obstructive et des anomalies de la dentition supérieure ont été associés à une plus grande incidence de LD. Un IMC plus élevé n’a pas d’influence sur les difficultés laryngoscopiques.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Tiberiu Ezri
    • 1
  • Beniamin Medalion
    • 2
  • Marian Weisenberg
    • 1
  • Peter Szmuk
    • 3
  • R. David Warters
    • 3
  • Ilan Charuzi
    • 4
  1. 1.Department of AnesthesiaWolfson Medical CenterHolonIsrael
  2. 2.Departments of Cardiothoracic SurgeryWolfson Medical CenterHolonIsrael
  3. 3.Departments of General Surgery “B”Wolfson Medical CenterHolon
  4. 4.Department of AnesthesiologyUniversity of Texas Medical School at HoustonTexasUSA

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