Michel Galinski1,2, Marine Chouteau3, Gessica Lunghi4, Marianne Vinurel4, Béatrice Blazy4, Mouni Cher4, Bruno Alouane4, Hélène Bento4, Jean-Louis Germain4, Christophe Barrat5, Jean Catineau6, Cédric Gil-Jardiné7, Christophe Baillard3. 1. Emergency Department - SAMU, Pellegrin Hospital, Bordeaux University Hospital, CHU de Bordeaux, F-33076, Bordeaux Cedex, France. michel.galinski@chu-bordeaux.fr. 2. Inserm, ISPED, Bordeaux Population Health Research Center INSERM U1219-"Injury Epidemiology Transport Occupation" Team, Bordeaux University, Bordeaux, France. michel.galinski@chu-bordeaux.fr. 3. Department of Anesthesiology and Critical Care Medicine, Cochin University Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Paris, France. 4. Department of Anesthesiology, Jean Verdier University Hospital, Paris 13 University, Assistance Publique-Hôpitaux de Paris, Bondy, Paris, France. 5. Department of Digestive and Metabolic Surgery, Jean Verdier University Hospital, Paris 13 University, Assistance Publique-Hôpitaux de Paris, Bondy, Paris, France. 6. Department of Anesthesiology and Critical Care Medicine, Princesse Grace Hospital, 98010, Monaco, Monaco. 7. Emergency Department - SAMU, Pellegrin Hospital, Bordeaux University Hospital, CHU de Bordeaux, F-33076, Bordeaux Cedex, France.
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.
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.