Morbid Obez Hastaların Hava Yolu Yönetiminde Videolaringoskopinin Yerinin ve Öneminin Belirlenmesi

Abstract

ABSTRACT BUYURGAN S. Significance of Videolaryngoscopy in Airway Management of Morbidly Obese Patients. Hacettepe University Faculty of Medicine Department of Anaesthesiology and Reanimation. Residency Thesis. Ankara, 2020. Introduction: Obesity is a multifactorial health problem and carries risks in terms of difficult airway management in anesthesia practice. Degree of obesity, demographic characteristics of patients such as age and gender, comorbidities such as obstructive sleep apnea syndrome (OSAS) affect these risks. Morbidity and mortality increase as a result of difficult or unsuccessful airway management. Thorough examination of the difficult airway determinants and taking necessary precautions is very important to protect the patient. There are different options for mask ventilation and endotracheal intubation in routine airway management. Methods and equipments to be preferred plays a critical role for successful airway management. In these study; we aim to examine the patients who underwent surgery under general anesthesia with body mass index (BMI) ≥30 kg/m² for airway management. Material/Methods: After obtaining ethics committee approval 375 patients who undergone elective surgery between January 2014-December 2018 under general anesthesia with a body mass index (BMI) ≥30 kg/m² were enrolled in the study. In our retrospective study, the patients’ anesthesia records were examined. Presence of difficult mask ventilation, two-handed mask ventilation, oral airway usage, difficult endotracheal intubation, the methods used for intubation and number of attempts for endotracheal intubation were recorded. Severity of the patients’ obesity, Modified Mallampati score, gender, age, presence of OSAS on difficult airway management were also evaluated. Results: As BMI increases, incidence of difficult mask ventilation and the need for two-handed mask ventilation also increases. However the increase in BMI seems to have no impact on the incidence of difficult endotracheal intubation. An increase in Mallampati score, is correlated with the incidence of difficult mask ventilation, two-handed mask ventilation, oral airway use and incidence of difficult endotracheal intubation incidence. There was no diffirence in terms of mask ventilation between male and female patients. However it was observed that difficult endotracheal intubation was more common in males. In patients with OSAS, the incidence of difficult mask ventilation and difficult endotracheal intubation were significantly higher. It was observed that endotracheal intubation success was decreased in first trial in patients with OSAS. The body weight and BMI values of patients intubated with videolaryngoscopy was found significantly higher compared to the patients who are intubated using direct laryngoscopy. Further clinical experience and studies are needed to evaluate these results. Conclusion: According to our study results, in terms of difficult airway management, obesity is an independent risk factor. Increase in BMI and Mallampati scores are associated with difficulty in airway management. The risks in airway management seem to be altered due to OSAS. Male gender is associated with a higher risk for difficult endotracheal intubation. We have provided confirmation of previous studies indicating the predictive value of BMI and Mallampati score, OSAS and male gender. We hope our data can serve to help anesthesiologists to get prepared for possible difficult airway in obese patients.

Key Words: Obesity, difficult airway, difficult mask ventilation, difficult endotracheal intubation, videolaryngoscopy