Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

doi:10.1590/S0034-70942011000100004

Scientific Article

Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

Reevaluation of the airways of obese patients undergone bariatric surgery after reduction in body mass index

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

http://dx.doi.org/10.1590/S0034-70942011000100004 Braz J Anesthesiol, vol.61, n1, p.35-40, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: A dificuldade na intubação traqueal é causa de mortalidade em anestesiologia e pode estar relacionada à obesidade. Diagnosticar uma intubação difícil contribui para o êxito da abordagem da via aérea, mas os parâmetros preditores de intubação difícil não estão bem estabelecidos. A classificação de Mallampati, a distância interincisivos, a circunferência do pescoço, a distância tireomentoniana e a presença da síndrome da apneia obstrutiva do sono são parâmetros que podem indicar uma intubação difícil. O tratamento cirúrgico da obesidade proporciona redução do índice de massa corpórea (IMC), com estabilização por volta de 2 anos. O objetivo desta pesquisa foi reavaliar os parâmetros descritos com os valores pré-cirúrgicos. MÉTODO: Cinquenta e um pacientes de ambos os sexos foram avaliados no período pré-operatório quanto a IMC, classificação de Mallampati, circunferência do pescoço, distância interincisivos, distância tireomentoniana e grau da síndrome de apneia obstrutiva do sono por meio da polissonografia. Após dois anos de cirurgia e redução do IMC < 35 kg.m-2, os preditores de intubação difícil foram reavaliados por outro médico anestesiologista com conhecimento do IMC prévio. Foram excluídos nove pacientes. Executou-se reavaliação dos parâmetros supracitados e, para os que não realizaram nova polissonografia, aplicou-se a escala de sonolência de Epiworth. RESULTADOS: Quarenta e dois pacientes foram reavaliados e mostraram redução do IMC e da circunferência do pescoço e aumento das distâncias interincisivos e tireomentoniana. Apenas um paciente apresentou redução na escala de Mallampati e somente quatro realizaram a polissonografia. CONCLUSÕES: A redução do IMC proporciona aumento das distâncias interincisivos e tireomentoniana e redução da circunferência do pescoço. O Mallampati permanece inalterado.

Palavras-chave

DOENÇA, Obesidade, INTUBAÇÃO TRAQUEAL, SISTEMA RESPIRATÓRIO, TÉCNICAS DE MEDIÇÃO, Índice de Massa Corporal

Abstract

BACKGROUND AND OBJECTIVES: Difficulty intubating is a cause of mortality in anesthesiology and it can be related to obesity. The diagnosis of difficult intubation contributes for successful airways management. However, parameters that predict difficult airways are not well established. Mallampati classification, the interincisor gap, neck circumference, thyromental distance, and the presence of obstructive sleep apnea, are parameters that can indicate difficult intubation. Surgical treatment of obesity provides reduction in body mass index (BMI) with stabilization after about 2 years. The objective of the present study was to reevaluate the parameters described above and compare them with pre-surgical values. METHODS: The BMI, Mallampati classification, neck circumference, interincisor gap, thyromental distance, and the degree of obstructive sleep apnea in polysomnography were evaluated in 51 patients of both genders in the preoperative period. Two years after the surgery and reduction of the BMI to < 35 kg.m-2, predictor factors of difficult airways were reevaluated by another anesthesiologist who knew the patients' BMI before surgery. Nine patients were excluded. The new reevaluation was performed, and for those who did not have another polysomnography the somnolence scale of Epiworth was applied. RESULTS: Forty-two patients were reevaluated. They showed a reduction in BMI and neck circumference, and an increase in both interincisor gap and thyromental distance. Only one patient showed a reduction in Mallampati scale, and only 4 patients performed polysomnography. CONCLUSIONS: Reduction of the BMI allows for an increased interincisor gap, thyromental distance, and reduction in neck circumference. Mallampati classification remains the same.

Keywords

Obesity, Body Mass Index, Airway Management, Intubation

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Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

Reevaluation of the airways of obese patients undergone bariatric surgery after reduction in body mass index

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

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