ASSESSING THE FREQUENCY OF DIFFICULT INTUBATION IN ADULT OBESE PATIENTS UNDERGOING GENERAL ANESTHESIA AT DISTRICT HEADQUARTERS HOSPITAL SWABI

Abstract

A prospective observational study was carried out at District Headquarter Hospital swabi, Pakistan. Total of 124 patients have participated in the study. Patients of both gender with age 18 and above years were included. An assessment of frequency of difficult intubation in obese patients was conducted using pre-formed questionnaire. Statistical package for social sciences version 22 were used for analysis of data. Descriptive statistics (frequencies, percentages and cross-tabulation) was applied to analyze the data. The study population comprised 124 adult patients, all classified as obese Based on the data, there was a high incidence of challenges with intubations in these obese cohort. This finding was caused by several factors which included some patients’ obesity, as 29% of patients (36/124) were intubated after more than three attempts while 28.2% (35/124) had intubation that lasted over 10 minutes. In 34.7% (43/124) of cases, an airway adjunct was found to be necessary. These led to a worrisome situation whereby significantly a greater number of the obese participants encountered difficult or failed intubation. Other anatomical features of the airway also proved worthwhile in further analysis. A good number, however, had poor oropharyngeal visualization, as demonstrated by the distribution of Mallam Patti scores (Grade 2: 29%; Grade 3: 32.3%; Grade 4: 3.2%). A good number of these patients (34.7%) also had stern omental distance less than twelve centimeters which could be associated with difficult intubation. These observations were corroborated by Cormack-Lehane classification, whereby 41.9% of participants demonstrated Class II view. this was an indicator on which we predicted that difficulty was likely to be experienced in 48 %. These findings disagree with the predicted 48% frequency of difficult intubation. In this study, the observed rate of difficult intubation was lower at 29%. This trend is vertically shown in the accompanying bar graph on which the expected and the actual frequency of the complication ‘difficult intubation’ has been plotted for all the 124 subjects. The decline in the observed rate has been as expected from the prediction. The purpose of the intubation was to maintain or secure the airway of the patient. Furthermore, this study included analysis of difficult intubation in obese patients among 124 subjects. Intubation challenges were of considerable concern during our analysis with 29% of the patients requiring more than 3 attempts, intubations exceeding 10 minutes were noted in 28.2% and airway adjuncts were required in 34.7% of the cases. As the authors state, a high rate of “atypical” anatomy was registered: unsatisfactory visualization of oropharynx, short stern omental distance, and Cormack-Lehane Classification II – III views were observed. However, the difficult intubation rate we observed 29% which is lower than our above predicted value of 48%.