1. The supraglottic airway device as first line of management in anticipated difficult mask ventilation in the morbidly obese
- Author
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Lakshmi Jayaraman, Dinesh Punhani, and Aparna Sinha
- Subjects
lcsh:RS1-441 ,body mass index ,Morbidly obese ,Logistic regression ,lcsh:RD78.3-87.3 ,lcsh:Pharmacy and materia medica ,STOPBANG ,Medicine ,Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics ,Apnea time ,Mask ventilation ,bariatric ,difficult airway ,Receiver operating characteristic ,obese ,business.industry ,Apnea ,neck circumference ,Supraglottic airway ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,Anesthesia ,Original Article ,medicine.symptom ,mask ventilation ,business ,Airway ,Body mass index - Abstract
Background and Aims: Supraglottic airway devices (SGAs) are used to rescue difficult and failed mask ventilation (DMV). We aimed to use the SGA as first-line device, prior to obtaining a definitive airway and to find any predictors of difficulty for the same, in the morbidly obese patients. Material and Methods: Obese surgical patients [body mass index (BMI) >35 kg/m2] were investigated. Difficulties with bag mask ventilation (MV) was graded using the following scale: MV-1, one anesthesiologist unassisted could achieve MV and maintain SpO2 >90%; MV-2, one additional anesthesiologist was needed to facilitate MV to achieve SpO2> 90%; MV-3, two additional anesthesiologists were needed for this purpose; and MV-3P, when a supraglottic device was required to ventilate and maintain SpO2more than 90%. Parameters studied were age, gender, neck circumference (NC), BMI, STOPBANG score, and safe apnea time (SAT). Results: Logistic regression was performed for predictors of MV-3P; receiver operating characteristic curve was used to locate the best cut-off. Analysis of 834 morbidly obese patients revealed an incidence of MV 1/2/3/3-P as 16%/38%/27%/19%, respectively. DMV was associated with BMI ≥50 kg/m2, NC ≥49.5 cm, and STOPBANG ≥6; P < 0.001. The mean SAT for a population with mean BMI 48 ± 8 kg/m2 was 256 ± 66 s. The SAT showed inverse relation to BMI and NC. As per our results, the NC was the single most important predictor of MV-3P, with sensitivity 0.62 and specificity 0.85 at best cut-off 49.5 cm; P < 0.001. Conclusion: NC ≥49.5 cm is strongly associated with low SAT and need for SGA to achieve MV. SGA may provide safety for initial management following induction of anesthesia in this patient population. more...
- Published
- 2020