Usefulness of an airway management protocol in the obese patient

Authors

Keywords:

difficult airway, airway management, obese patient

Abstract

Introduction: there are several difficult airway algorithms; However, some authors consider that the extrapolation of recommendations created for the general population has served as a guide in the management of the obese patient without considering their weight. Objective: to determine the usefulness of an airway management protocol in the obese patient. Method: a descriptive and developmental study was carried out in the Surgical Unit of the “Manuel Fajardo Rivero” Hospital of the City of Santa Clara in the period from September 2014 to April 2018. The population was made up of the total obese patients programmed for elective surgery with general anesthesia. An intentional non-probabilistic sampling was performed, the sample was made up of patients who met the defined inclusion and exclusion criteria. An airway management protocol designed by the authors was applied, which included various plans for intubation and ventilation of the obese patient and the usefulness of the protocol was related to variables of interest. Results: the airway could be established by conventional laryngoscopy in the largest number of cases (81.3%), a small number of patients (16.2%) presented adverse incidents, the protocol was mostly useful (70%) and in all obese groups, according to the body mass index, the protocol had a high percentage of utility (95.1%). Conclusions: the application of the protocol allowed the establishment of the airway and was useful in the majority of patients.

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Author Biographies

Ada Nersys Consuegra Carvajal, Hospital Clínico Quirúrgico "Comandante Manuel Fajardo Rivero"

Especialista en I Grado en Anestesiología y Reanimación. Máster en Urgencias Médicas de la Atención Primaria de Salud. Profesora Asistente de la Universidad de Ciencias Médicas de Villa Clara.

Adonis Freire Ramos, Hospital Clínico Quirúrgico "Comandante Manuel Fajardo Rivero"

Especialista en I Grado en Medicina General Integral. ESpecialista en I Grado en Anestesiología y Reanimación.

Juan Miguel Rodríguez Rueda, Hospital Clínico Quirúrgico "Comandante Manuel Fajardo Rivero"

Especialista en I y II Grado en Medicina Interna. Especialista en II Grado en Medicina Intensiva y Emergencia. Máster en Urgencias Médicas de la Atención Primaria de Salud. Doctor en Ciencias Médicas. Profesor Auxiliar en la Universidad de Ciencias Médicas de Villa Clara.

Aina Jiménez García, Hospital Clínico Quirúrgico "Comandante Manuel Fajardo Rivero"

Especialista en I Grado en Medicina General Integral. Especialista en I Grado en Medicina Intensiva y Emergencia.

References

1. World Health Organization, Global Health Observatory data. Overweight and obesity [Internet]. Geneva: WHO; 2019 [citado 30 Mar 2019]. Disponible en: https://www.who.int/gho/ncd/risk_factors/overweight_text/en/

2. Villalobos Ramírez L, Aceves-López LA, Rivera-Ordoñez A. Titulación farmacológica en el paciente obeso y manejo de la vía aérea. Rev Mex Anest [Internet]. 2017 Abr-Jun [citado 30 Mar 2019];40(1):264-267. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2017/cmas171cc.pdf

3. Doyle DJ. Airway anesthesia: Theory and practice. Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):291-304. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25999003. https://doi.org/10.1016/j.anclin.2015.02.013

4. Danielson DR. Management of the Difficult Airway. En: Murray MJ, Rose SH. Faust’s anesthesiology review. Philadelphia: Elsevier; 2015. p. 567-68.

5. Baker P. Preparedness and education in airway management. Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):381-95. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25999010. https://doi.org/10.1016/j.anclin.2015.02.007

6. Berkow LC, Ariyo P. Preoperative assessment of the airway. Trends in anaesthesia and critical care [Internet]. 2015 Feb [citado 30 Mar 2019];5(1):28-35. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S2210844014200220

7. Chaparro-Mendoza K, Luna-Montúfar CA, Gómez JM. Videolaringoscopios: ¿la solución para el manejo de la vía aérea difícil o una estrategia más? Revisión no sistemática. Rev Colomb Anestesiol [Internet]. 2015 Jul-Sep [citado 30 Mar 2019];43(3):225-233. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0120334715000453. https://doi.org/10.1016/j.rca.2015.03.012

8. Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev [Internet]. 2016 Nov [citado 30 Mar 2019];15;11:CD011136. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472630/. https://doi.org/10.1002/14651858.CD011136.pub2

9. Artime CA, Hagberg CA. Is there a gold standard for management of the difficult airway? Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):233-40. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S1932227515000282. https://doi.org/10.1016/j.anclin.2015.02.011

10. Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: A cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia [Internet]. 2015 Mar [citado 30 Mar 2019];70(3):272-81. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25511370. https://doi.org/10.1111/anae.12955

11. Baker P. Assessment before airway management. Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):257-78. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25999001. https://doi.org/10.1016/j.anclin.2015.02.001

12. Leykin Y, Brodsky JB. Controversies in the Anesthetic Management of the Obese Surgical Patient. BJA [Internet]. 2014 Dec [citado 30 Mar 2019];113(6):1063-1064. Disponible en: https://academic.oup.com/bja/article/113/6/1063/250732

13. Gómez Ríos MA, Gaitini L, Matter I, Somri M. Guías y algoritmos para el manejo de la vía aérea difícil. Rev Esp Anestesiol Reanim [Internet]. 2018 Ene [citado 30 Mar 2019];65(1):41-48. Disponible en: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0034935617301998.pdf. https://doi.org/10.1016/j.redar.2017.07.009

14. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth [Internet]. 2015 Dec [citado 30 Mar 2019];115(6):827-48. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650961/. https://doi.org/10.1093/bja/aev371

15. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia [Internet]. 2015 Nov [citado 30 Mar 2019];70(11):1286-1306. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606761/. https://dx.doi.org/10.1111/anae.13260

16. Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth [Internet]. 2015 [citado 30 Mar 2019];25(4):346-362. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25684039. https://doi.org/10.1111/pan.12615

17. Mariscal M, Pindado ML, Pérez H, Duro E. Algoritmos vía aérea difícil [Internet]. 2020 [citado 2 Feb 2020]. Disponible en: http://arydol.com/temas/secciones/via-aerea/via-aerea-dificil/algoritmos-via-aerea-dificil/

18. Huitink JM, Bouwman RA. The myth of the difficult airway: airway management revisited. Anaesthesia [Internet]. 2015 Mar [citado 30 Mar 2019];70(3):244-249. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.12989. https://doi.org/10.1111/anae.12989

19. Ogunnaike BO, Whitten ChW. Evaluation of the obese patient. En: Longneker DE. Anesthesiology. New York: Mc Graw-Hill Companies; 2008. p. 375.

20. Gómez García J, Fernández Vaquero MA. Manejo de vía aérea en pacientes con obesidad mórbida. Rev Elec AnestesiaR. [Internet]. 2014 Jun [citado 30 Mar 2019];6(6):[aprox. 4 p.]. Disponible en: http://revistaanestesiar.org/index.php/rear/article/view/231. https://doi.org/https://doi.org/10.30445/rear.v6i6.231

21. Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology [Internet]. 1997 Dec [citado 30 Mar 2019];87(6):1290-97. Disponible en: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1948562

22. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia [Internet]. 1984 Nov [citado 30 Mar 2019];39(11):1105-11. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/6507827. https://doi.org/10.1111/j.1365-2044.1984.tb08932.x

23. Mariscal Flores ML, Martínez Hurtado ED. Manual de manejo de la vía aérea difícil [Internet]. 3ra ed. Anestesia R; 2018 [actualizado 15 enero 2018; citado 30 Mar 2019]. Disponible en: https://anestesiar.org/2018/manual-de-manejo-de-la-via-aerea-dificil-3a-edicion/102/

24. Consuegra Carvajal AN, Rodríguez Rueda JM, Pérez Socorro D, Benítez Pérez MO, Quintero Sarduy N, Mora Guane I. Manejo de la ventilación durante la fibrobroncoscopia con máscara laríngea. Acta Méd Centro [Internet]. 2016 [citado 30 Mar 2019];10(2):31-38. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/440/636

25. Consuegra Carvajal AN, Rodríguez Rueda JM, Quintero Sarduy N, Mora Guane IC, Pérez Socorro D. Manejo de la máscara laríngea Proseal por diplomantes de la Especialidad de Anestesia. Acta Méd Centro [Internet]. 2016 [citado 30 Mar 2019];10(4):18-26. Disponible en: http://www.revactamedicacentro.sld.cu/index.php/amc/article/view/759/1002

26. Akulian JA, Yarmus L, Feller-Kopman D. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management. Anesthesiol Clin [Internet]. 2015 Jun [citado 30 Mar 2019];33(2):357-67. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25999008. https://doi.org/10.1016/j.anclin.2015.02.009

27. Kristensen MS, Teoh WH, Baker PA. Percutaneous emergency airway access; prevention, preparation, technique and training. Br J Anaesth [Internet]. 2015 Mar [citado 30 Mar 2019];114(3):357-61. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25694555. https://doi.org/10.1093/bja/aev029

28. Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: Physiologic basis, benefits, and potential risks. Anesth Analg [Internet]. 2017 Feb [citado 30 Mar 2019];124(2):507-517. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28099321. https://doi.org/10.1213/ANE.0000000000001589

29. Wong DT, Yee AJ, Leong SM, Chung F. The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: A narrative review. Can J Anaesth [Internet]. 2017 Apr [citado 30 Mar 2019];64(4):416-427. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28050802. https://doi.org/10.1007/s12630-016-0802-z

30. Kohl BA, Hanson CW. Protocolos de cuidados críticos y soporte a la decisión. En: Miller RD, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N. Miller Anestesia. 8va ed. España: Elsevier; 2016. p. 3053-60.

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Published

2020-03-23

How to Cite

1.
Consuegra Carvajal AN, Freire Ramos A, Rodríguez Rueda JM, Jiménez García A. Usefulness of an airway management protocol in the obese patient. Acta Méd Centro [Internet]. 2020 Mar. 23 [cited 2025 Jul. 2];14(2):210-21. Available from: https://revactamedicacentro.sld.cu/index.php/amc/article/view/1131

Issue

Vol. 14 No. 2 (2020): April-June

Section

Original Articles

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