ABSTRACT
BACKGROUND: Previous studies have failed to detect high body mass index (BMI) as a risk factor for difficult tracheal intubation (DTI). BMI was investigated as a risk factor for DTI in patients planned for direct laryngoscopy. METHODS: A cohort of 91,332 consecutive patients planned for intubation by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use of neuromuscular blocker, and BMI were retrieved. Logistic regression to assess whether BMI was associated with DTI was performed. RESULTS: The frequency of DTI was 5.2% (95% confidence interval [CI] 5.0-5.3). In multivariate analyses adjusted for other significant covariates, BMI of 35 or more was a risk for DTI with an odds ratio of 1.34 (95% CI 1.19-1.51, P < 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an odds ratio of 1.031 (95% CI 1.002-1.061, P < 0.04). CONCLUSIONS: High BMI is a weak but statistically significant predictor of difficult and failed intubation and may be more appropriate than weight in multivariate models of prediction of DTI.
Subject(s)
Body Mass Index , Intraoperative Complications/epidemiology , Intubation, Intratracheal/statistics & numerical data , Obesity/complications , Overweight/complications , Analysis of Variance , Body Height/physiology , Body Weight/physiology , Databases, Factual , Denmark/epidemiology , Female , Humans , Laryngoscopy , Male , Middle Aged , Neuromuscular Blockade , Predictive Value of Tests , Prospective Studies , ROC Curve , Regression Analysis , Risk Factors , Sample Size , Treatment FailureABSTRACT
Surgical patients with pulmonary disease are at increased risk of developing postoperative pulmonary complications and some patients may need postoperative ventilatory support. Stratifying and planning the right strategies for these patient categories are important since complications increase morbidity and mortality. Predictive tests, however, are few and preoperative interventions are of limited value. This brief review summarizes the current knowledge on perioperative measures to reduce pulmonary complications.
