Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000300006
Brazilian Journal of Anesthesiology
Scientific Article

Uso de preditores clínicos simples no diagnóstico pré-operatório de dificuldade de intubação endotraqueal em pacientes portadores de obesidade

Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients

Edno Magalhães; Felipe Oliveira Marques; Cátia Sousa Govêia; Luis Cláudio Araújo Ladeira; Jader Lagares

http://dx.doi.org/10.1590/S0034-70942013000300006 Braz J Anesthesiol, vol.63, n3, p.262-266, 2013
PDF Português
PDF English
Downloads: 0
Views: 1060

Resumo

JUSTIFICATIVA E OBJETIVOS: Apesar da semelhante incidência de dificuldade à laringoscopia em obesos e não obesos há mais relatos de dificuldade de intubação endotraqueal em portadores de obesidade. Alternativas de diagnóstico e previsão de dificuldade de intubação no pré-operatório podem ajudar diminuir complicações anestésicas em indivíduos obesos. O objetivo do estudo foi identificar preditores para diagnóstico de via aérea difícil em pacientes obesos, pela correlação com métodos clínicos de avaliação pré-anestésica e polissonografia. Comparou-se também a incidência de dificuldade à ventilação sob máscara facial e à laringoscopia entre obesos e não obesos, verificando os preditores mais prevalentes. MÉTODOS: Estudo observacional, prospectivo, comparativo, com 88 pacientes adultos, submetidos à anestesia geral. No período pré-operatório, avaliou-se questionário sobre preditores clínicos de síndrome da apneia obstrutiva do sono (SAOS) e parâmetros anatômicos. Durante a anestesia, pesquisou-se dificuldade à ventilação sob máscara facial e laringoscopia. Para análise, estatística descritiva e teste de correlação. RESULTADOS: Os pacientes foram alocados em dois grupos, 43 obesos e 45 não obesos. Estado físico, prevalência de roncos, hipertensão e diabetes mellitus, circunferência cervical e índice de Mallampati foram maiores nos obesos. Pacientes obesos apresentaram maior incidência de dificuldade de ventilação sob máscara e laringoscopia. Nenhuma variável clínica ou anatômica apresentou correlação com dificuldade de ventilação sob máscara nos grupos. Nos obesos, o diagnóstico de SAOS mostrou forte correlação com dificuldade à laringoscopia. CONCLUSÕES: Os diagnósticos clínico e polissonográfico de SAOS se mostraram úteis no diagnóstico pré-operatório de dificuldade à laringoscopia. Pacientes obesos estão mais propensos à dificuldade de ventilação sob máscara e laringoscopia.

Palavras-chave

DOENÇAS, Obesidade, INTUBAÇÃO TRAQUEAL, Medição de Risco, Síndromes da Apnéia do Sono

Abstract

BACKGROUND AND OBJECTIVES: Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. METHODS: Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. RESULTS: Patients were allocated into two groups: obese group (n = 43) and non-obese group (n = 45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. CONCLUSIONS: The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy.

Keywords

Intubation, Intratracheal, Obesity, Sleep apnea, Obstructive, Risk Assessment

References

Mancini MC. Diagnóstico e classificação da obesidade. Cirurgia da obesidade. 2002:1-7.

Simoni RF. Anestesia para cirurgia bariátrica.. Tratado de anestesiologia. 2006:1595-613.

Juvin P, Lavaut E, Dupont H. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595-600.

Kim WH, Ahn HJ, Lee CJ. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesthesia. 2011;106:743-748.

Martins AB, Tufik S, Moura SMGPT. Síndrome da apneia-hipopneia obstrutiva do sono: Fisiopatologia. J Bras Pneumol. 2007;33(1):93-100.

Braga AFA, Silva ACM, Cremonesi E. Obesidade mórbida: considerações clínicas e anestésicas. Rev Bras Anestesiol. 1999;49:201-12.

Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110:928-39.

Brodsky JB, Lemmens HJM, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94:732-736.

Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesthesia. 2001;13:144-156.

Punjabi NM. The epidemiology of adult obstructive sleep apnea. Am Thorac Soc. 2008;5:136-143.

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;109:1182-6.

Ramachandran SK, Kheterpal S, Consens F, Shanks A, Doherty TM, Morris M, Tremper KK. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg. 2010;110:1007-15.

Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography. Ann Intern Med. 2007;146:157-166.

Herer B, Roche N, Carton M, Roig C, Poujol V, Huchon G. Value of clinical, functional, and oximetric data for the prediction of obstructive sleep apnea in obese patients. Chest. 1999;116(6):1537-1544.

Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg. 2008;107:138-43.

Blake DW, Chia PH, Donnan G, Williams DL. Preoperative assessment for obstructive sleep apnoea and the prediction of postoperative respiratory obstruction and hypoxaemia. Anaesth Intens Care. 2008;36:379-84.

Gross JB, Bachenberg KL, Benumof JL. 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;104:1081-93.

Kirby SD, Engl P, Danter W. Neural network prediction of obstructive sleep apnea from clinical criteria. Chest. 1999;116:409-15.

Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. AnnIntern Med. 1997;127:581-7.

Chung F, Yegneswaran B, Liao P. Stop questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812-21.

Chung F, Yegneswaran B, Liao P. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822-30.

Liistro G, Rombaux P, Belge C, Dury M, Aubert G, Rodenstein DO. High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea. Eur Respir J. 2003;21:248-52.

Toshiya S, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients. Anesthesiology. 2005;103:429-437.

5dd423040e88252f0dc63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections