title: Does Body Mass Index Reduction by Bariatric Surgery Affect Laryngoscopy Difficulty During Subsequent Anesthesia?
abstract: The effect of body mass index (BMI) reduction following bariatric surgery on subsequent airway management has not been investigated. This study aimed to investigate the association between BMI reduction and airway assessment and management measured by Mallampati class (MC) and laryngoscopy grade (LG).
  
  
  
  We conducted a retrospective study over 6 years to compare the BMI changes, MC and LG in patients having weight reduction bariatric surgery followed by subsequent surgery. Data was extracted from the anesthesia records of patients undergoing laparoscopic band insertion (LBI) and laparoscopic sleeve gastrectomy (LSG). Difficult airway was defined as Malampati class 3 and 4 on a 1-4 difficulty scale or laryngoscopy grade >2 on a 1-4 difficulty scale and need for unplanned fiberoptic intubation. Changes in these variables were correlated with weight reduction. Statistical analysis included t test, univariante, and multivariant logistic regression.
  
  
  
  Five hundred forty-six patients underwent LSG and 83 patients had LBI during the study period. Of those patients, 65 patients had subsequent surgical procedures after the bariatric procedure. Of the 65 patients identified, 62 were eligible. BMI decreased by approximately13 kg/m2(p = 0.000) which roughly represents a 30 % reduction between the two surgical procedures. Mallampati class decreased significantly (p = 0.000) while laryngoscopy grade did not (p = 0.419).
  
  
  
  Our study revealed that a significant reduction in BMI was associated with a significant decrease in Mallampati class. There was no significant decrease in laryngoscopy grade, and there was no case of unplanned fiberoptic intubation.
authors: Department of Surgery A, Wolfson Medical Center, Holon, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. shimonovdr@gmail.com.|Department of Surgery A, Wolfson Medical Center, 62 Halochamim Street, 58100, Holon, Israel. shimonovdr@gmail.com.
authors: Mordechai
authors: M
authors: Shimonov
authors: Department of Surgery A, Wolfson Medical Center, Holon, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors: Pinhas
authors: P
authors: Schechter
authors: Department of Epidemiology & Research Unit Wolfson Medical Center, Holon, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.|Department of Anesthesia, Poriya Medical Center, Tiberias, affiliated to the Faculty of Medicine in the Galilee, Bar Ilan University, Ramat Gan, Israel.
authors: Mona
authors: M
authors: Boaz
authors: Department of Nutrition Sciences School of Health Sciences, Ariel University, Ariel, Israel.
authors: Ronen
authors: R
authors: Waintrob
authors: Department of Anesthesia, Wolfson Medical Center, Holon, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.|Outcomes Research Consortium, Cleveland, OH, USA.
authors: Tiberiu
authors: T
authors: Ezri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy; D007828:Laryngoscopy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: BMI; Bariatric surgery; Laryngoscopy difficulty; Subsequent general surgery