title: Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Anesthesiology Center, Universidade de Brasília, Hospital Universitário de Brasília, Brasília, DF, Brazil. ednomag@gmail.com
authors.forename: Edno
authors.initials: E
authors.lastname: Magalhães
authors.forename: Felipe
authors.initials: F
authors.lastname: Oliveira Marques
authors.forename: Cátia
authors.initials: C
authors.lastname: Sousa Govêia
authors.forename: Luis Cláudio
authors.initials: LC
authors.lastname: Araújo Ladeira
authors.forename: Jader
authors.initials: J
authors.lastname: Lagares
mesh_terms: D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies