Neck circumference as a potential indicator of difficult intubation in obese patients: A comparative study

DR. SWEETY BHOLA; DR.RAJKUMAR AHIRWAL

Volume : VIII, Issue : I, January - 2019

Neck circumference as a potential indicator of difficult intubation in obese patients: A comparative study

Dr. Sweety Bhola, Dr. Rajkumar Ahirwal

Abstract :

Introduction: Airway management has always been a trending topic because its failure is one of the biggest threat in anesthesiology. The incidence of difficult laryngoscopy and intubation in obese patients is much higher than in the general population. Routine predictors of difficult laryngoscopy and intubation have been shown to be unreliable many times. Aims & objectives: The aim of this study was to compare the incidence of difficult tracheal intubation, with the help of IDS score, between obese and lean patients along with bedside tests and neck circumference. MATERIAL AND METHODS: The present study is a prospective comparative study between age group 18 – 50 years of both sexes belonging to ASA grade I & II. 60 patients will be divided into 2 groups (n = 30) obese & lean,will be schedule for surgeries under general aneasthesia. IDS scores, categorized as difficult intubation (IDS >5) or not (IDS ≤5), and the patient data, were compared between lean and obese patients. Preoperative measurements of BMI, neck circumference (at the level of the thyroid cartilage), mouth opening, sternomental distance and thyromental distance, medical history of obstructive sleep apnea syndrome, and some scores (Mallampati, Wilson, El Ganzouri) were recorded. The view during direct laryngoscopy was graded, and the IDS was recorded. Then we have compared patients with IDS >5 and ≤5, taking each item mainly neck circumference. RESULT& CONCLUSION: The results indicate that difficult tracheal intubation is more frequent in obese than in lean patients (15.8% vs 4%; P = 0.03). In the patients with IDS >5, thyromental distance, BMI, large neck circumference, and Mallampati score≥3 were the only predictors of potential intubation problems. We found that neck circumference should be estimated preoperatively to predict difficult intubation which gives better accuracy in obese patients.