Evaluation of Ultrasound Measurements of Anterior Neck Soft Tissue and Other Predictors of Difficult Laryngoscopy in Morbidly Obese Patients
Canan Yılmaz1, Derya Karasu1, Evren Dilektaşlı2, Ahmed Taha2, Şeyda Efsun Özgünay1, Gülsen Korfalı1
1Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Traninig and Education Hospital, Bursa, Turkey
2Department of General Surgery, Bursa Yuksek Ihtisas Traninig and Education Hospital, Bursa, Turkey
OBJECTIVE: The aim of our study was to compare the USG measurements of anterior neck soft tissue and other clinical screening tests for difficult laryngoscopy in morbidly obese patients. MATERIAL-METHODS: One hundred thirthy morbidly obese patients were scheduled for laparoscopic weight reduction surgery in this prospective trial. The USG examination was performed at vocal cords (zone 1), thyroid isthmus (zone 2), and suprasternal notch (zone3) levels. An anaesthesiologist who were unaware of the clinical screening variables and USG results performed laryngoscopy and trachea was intubated without styleted.When second attempt for intubation was failed, useage of other difficult intubation equipments were planned. Third attempt for intubation was applied by an other experienced anaesthesiologist.If intubation failed after three attempts, the study ended and patient was awakened. RESULTS: Fifty six of 130 patients excluded from study because of not meeting inclusion criteria. Laryngoscopic view was graded according to Cormack and Lehane's scale to decide difficult laryngoscopy.7 patients were classified as having difficult laryngoscopy (9.5%). All of the patients were entubated succesfully within 3 attempts. Patients with difficult laryngoscopy were significantly older than patients with easy laryngoscopy.The incidence of difficult laryngoscopy significantly higher in patients with diabetes mellitus, hypertension and OSAS. Intubation difficulty scale (IDS) ≥5, high incidence of neck mobility problems, and high number of intubation attempts were found significantly higher in difficult laryngoscopy group.Measurements of sternomental distance for difficult laryngoscopy and easy laryngoscopy were 11,5±3.75 and 14.18±2.63 respectively.BURP maneuver was performed higher incidence rate in difficult laryngoscopy group. The requirement of useage a styleted endotracheal tube in difficult laryngoscopy group was more frequently. CONCLUSION: We thought that USG measurement of anterior neck soft tissue has no influence on the difficult laryngoscopy in morbidly obese patients. Amoung the other potential predictors we evaluated, IDS ≥5 was the only powerful predictor of diffucult laryngoscopy.
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