Airway management experiences in bariatric surgery

Abstract

Objective: Obese patients are hazardous due to airway morbidity as against to the non-obese. However, there are contradictory data about predicting factors of tracheal intubation and mask ventilation in morbidly obese people. Methods: We studied 196 patients undergone laparoscopic sleeve gastrectomy surgery. Neuromuscular blockade (NMB) was achieved with rocuronium. At the end of the surgery, complete reversal of NMB was obtained with sugammadex. Mallampati scores, Cormack-Lehane scores, number of intubation attempts, ventilation and OSAS descriptives were recorded. Results: Mallampati 4 scores were related to higher difficult ventilation situation and OSAS. Also, none of Cormack-Lehane 4 scores were intubated at first attempt. Higher Cormack-Lehane scores (3 and 4) were related to higher difficult ventilation situation and OSAS. During standard induction and transtracheal intubation, the sense of concern in anesthesiologists was recorded as none, moderate and high. During 98.5% of standard induction and transtracheal intubation, anesthesiologists declared they had no concerns. Difficult ventilation situation was not related to age. OSAS was related to higher ages. Conclusion: BMI is not a predictable factor for difficult intubation,however difficult mask ventilation can predict difficult intubation in obese patients because of anatomical reasons. Also presence of obstructive sleep apnea syndrome (OSAS) and high Mallampati class situations may cause difficult intubation. Presence of sugammadex in the operating room may encourage anesthesiologists.