Review Article

Airway Assessment and Management of Obese Patients in Operation Room and PACU; A Narrative Review

Abstract

The most difficulties in airway management of obese individuals are due to obesity-associated anatomic and physiologic changes in airways and respiratory system. Anesthesiologists usually face some problems, such as quick oxygen desaturation, difficult mask ventilation, difficulty in laryngoscopy/intubation, and respiratory depression, following initiation of hypnotic anesthetic medications. Awareness of the physiologic and anatomic changes may help anesthesiologist in providing better preparation before tackling those difficulties. Preparative evaluation of airway in obese persons should include inspection of predictors of difficult mask ventilation and difficult intubation. Difficulties in airway management are reduced after giving ideal preoxygention and positioning using some strategies may lead to facilitate airway management of these patients and reduce some hazards in this field.

Monasta L, Batty G, Macaluso A, Ronfani L, Lutje V, Bavcar A, et al. Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials. Obes Rev. 2011; 12(5):e107-18.

Nandi P, Charlesworth C, Taylor S, Nunn J, Dore C. Effect of general anaesthesia on the pharynx. Br J Anaesth. 1991; 66(2):157-62.

Sweeting HN. Measurement and definitions of obesity in childhood and adolescence: a field guide for the uninitiated. Nutr J. 2007; 6(1):32.

Al-Jumaili FT. Evaluation of Some Inflammatory and Biochemical Markers in Obese and Lean Iraqi Women. Journal of Al-Nahrain University Science. 2014; 71(4):168-73.

Dargin J, Medzon R. Emergency department management of the airway in obese adults. Ann Emerg Med. 2010 ;56(2):95-104.

Lundstrøm LH, Møller AM, Rosenstock C, Astrup G, Wetterslev J. High Body Mass Index Is a Weak Predictor for Difficult and Failed Tracheal IntubationA Cohort Study of 91,332 Consecutive Patients Scheduled for Direct Laryngoscopy Registered in the Danish Anesthesia Database. Anesthesiology. 2009; 110(2):266-74.

Ezri T, Medalion B, Weisenberg M, Szmuk P, Warters RD, Charuzi I. Increased body mass indexper se is not a predictor of difficult laryngoscopy. Can J Anaesth 2003;50(2):179-83.

Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002; 94(3):732-6.

Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP, Ochroch EA. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesth Analg. 2009;109(4):1182-6.

Aceto P, Perilli V, Modesti C, Ciocchetti P, Vitale F, Sollazzi L. Airway management in obese patients. Surg Obes Relat Dis. 2013; 9(5):809-15.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003; 98(5):1269-77.

Ezri T, Medalion B, Weisenberg M, Szmuk P, Warters RD, Charuzi I. Increased body mass indexper se is not a predictor of difficult laryngoscopy. Can J Anaesth. 2003; 50(2):179-83.

Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP, Ochroch EA. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesth Analg. 2009; 109(4):1182-6.

Kim W, Ahn H, Lee C, Shin B, Ko J, Choi S, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth. 2011;106(5):743-8.

Ezri T, Gewürtz G, Sessler D, Medalion B, Szmuk P, Hagberg C, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003; 58(11):1111-4.

Dargin J, Medzon R. Emergency department management of the airway in obese adults. Annals Emergency Medicine. 2010; 56(2):95-104.

Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000; 92(5):1229-36.

Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’reilly M, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006; 105(5):885-91.

Damia G, Mascheroni D, Croci M, Tarenzi L. Perioperative changes in functional residual capacity in morbidly obese patients. BJA: Br J Anaesth. 1988; 60(5):574-8.

Brodsky JB, Lemmens HJ, Brock-Utne JG, Saidman LJ, Levitan R. Anesthetic considerations for bariatric surgery: proper positioning is important for laryngoscopy. Anesth Analg. 2003; 96(6):1841-2.

Myatt J, Haire K. Airway management in obese patients. Curr Anaesth Crit Care. 2010; 21(1):9-15.

Perilli V, Sollazzi L, Bozza P, Modesti C, Chierichini A, Tacchino RM, et al. The effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg. 2000; 91(6):1520-5.

Boyce JR, Ness T, Castroman P, Gleysteen JJ. A preliminary study of the optimal anesthesia positioning for the morbidly obese patient. Obes Surg. 2003;13(1):4-9.

Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005; 100(2):580-4.

Perilli V, Sollazzi L, Modesti C, Annetta M, Sacco T, Bocci M, et al. Comparison of positive end-expiratory pressure with reverse Trendelenburg position in morbidly obese patients undergoing bariatric surgery: effects on hemodynamics and pulmonary gas exchange. Obes Surg. 2003;13(4):605-9.

Freid EB. The rapid sequence induction revisited: obesity and sleep apnea syndrome. Anesthesiol Clin North America. 2005; 23(3):551-64.

Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology. 2003; 99(1):60-4.

Mellin‐Olsen J, Fasting S, Gisvold S. Routine preoperative gastric emptying is seldom indicated. A study of 85 594 anaesthetics with special focus on aspiration pneumonia. Acta Anaesthesiol Scand. 1996; 40(10):1184-8.

Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anesth. 2007; 54(9):748-64.

Domi R, Laho H. Anesthetic challenges in the obese patient. J Anesth. 2012; 26(5):758-65

Apfelbaum J, Caplan R, Connis R, Epstein B, Nickinovich D, Warner M. American Society of Anesthesiologists Committee: Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011; 114(3):495-511.

Zoremba M, Aust H, Eberhart L, Braunecker S, Wulf H. Comparison between intubation and the laryngeal mask airway in moderately obese adults. Acta Anaesthesiol Scand. 2009; 53(4):436-42.

Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anesth. 1995; 42(11):1017-23.

Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth. 1995; 7(4):297-305.

Marrel J, Blanc C, Frascarolo P, Magnusson L. Videolaryngoscopy improves intubation condition in morbidly obese patients. Eu J anaesth. 2007; 24(12):1045-9.

Dhonneur G, Abdi W, Ndoko SK, Amathieu R, Risk N, El Housseini L, et al. Video-assisted versus conventional tracheal intubation in morbidly obese patients. Obes Surg. 2009; 19(8):1096-101.

Archan S, Prause G, Gumpert R, Seibert FJ, Kügler B. Cricothyroidotomy on the scene in a patient with severe facial trauma and difficult neck anatomy. Am J Emerg Med. 2009; 27(1):133.e1-4.

Wieczorek P, Schricker T, Vinet B, Backman S. Airway topicalisation in morbidly obese patients using atomised lidocaine: 2% compared with 4%. Anaesthesia. 2007; 62(10):984-8.

Vennila R, Hall A, Ali M, Bhuiyan N, Pirotta D, Raw D. Remifentanil as single agent to facilitate awake fibreoptic intubation in the absence of premedication. Anaesthesia. 2011; 66(5):368-72.

La Colla L, La Colla G, Albertin A, Poli D, Baruffaldi Preis F, Mangano A. The use of propofol and remifentanil for the anaesthetic management of a super‐obese patient. Anaesthesia. 2007; 62(8):842-5.

Gallagher SF, Haines KL, Osterlund LG, Mullen M, Downs JB. Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. J Surg Res. 2010; 159(2):622-6.

Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery. Circulation. 2009; 120(1):86-95.

Davidson JE, Kruse MW, Cox DH, Duncan R. Critical care of the morbidly obese. Crit Care Nurs Q. 2003; 26(2):105-16.

Lars l. Eriksson, Lee A. Fleisher, Jeanine P. Wiener-Kronish, William L. Young . Miller's Anesthesia. Elsevier Health Sciences;.1 2009.

Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132(1):325-37.

Sullivan C, Berthon-Jones M, Issa F, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 317(8225):862-5.

Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E. Noninvasive positive pressure ventilation via face mask: first-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest. 1996; 109(1):179-93.

Ramirez A, Lalor PF, Szomstein S, Rosenthal RJ. Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux-en-Y gastric bypass: is it safe? Surg Obes Relat Dis. 2009; 5(5):544-6.

Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006; 104(5):1081.

Files
IssueVol 4 No 1 (2018): Winter QRcode
SectionReview Article(s)
Keywords
obesity airway assessment airway management

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Khan ZH, Mohammadi M, Bannay H. Airway Assessment and Management of Obese Patients in Operation Room and PACU; A Narrative Review. Arch Anesth & Crit Care. 2018;4(1):436-439.