Prediction of difficult laryngoscopy: does obesity play a role?
OBJECTIVE
This study was intended to 1) identify preoperative predictors of difficult laryngoscopy and 2) determine the role of obesity in difficulty of obtaining adequate laryngeal exposure.


METHODS
A prospective study was undertaken of 63 patients who were undergoing elective direct laryngoscopy. Thirty-six patients met the obesity criteria (body mass index of at least 30 kg/m2). Measurements of height, weight, and neck circumference and Mallampati and Cormack-Lehane scores were obtained. The ease of laryngeal exposure was recorded by the attending surgeon on a visual analog scale (VAS; 1 to 10). Difficult laryngeal exposure (DLE) was defined as a VAS score of at least 3. The candidate morphological predictors were investigated.


RESULTS
Obesity and Mallampati score were found to be predictors of DLE (p < .001). The VAS score was positively correlated with body mass index (p = .007), weight (p = .05), Mallampati score (p < .001), and Cormack-Lehane score (p < .001). Among obese patients, the VAS score was correlated with the Cormack-Lehane score (p = .01), whereas in nonobese patients the VAS score showed a significant association with both the Mallampati (p = .02) and Cormack-Lehane (p = .01) scores.


CONCLUSIONS
Obese patients and those with a Mallampati score of at least 2 posed a significantly higher risk of DLE. Preoperative identification of a potentially difficult airway may aid surgical planning and allow more effective communication with a collaborating anesthesiologist.
Hekiert
Adrianna M
AM
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 3400 Spruce St, 5th Floor Ravdin Bldg, Philadelphia, PA 19104, USA.
Mick
Rosemarie
R
Mirza
Natasha
N
D015992:Body Mass Index; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors