Is Obesity Associated With Difficult Intubation: A Report Based on 731 Adult
Patients Using Rapid Sequence Intubation?
Claude D. Brunson MD*, Jun Pan MD*, Antrione E. Evans BS*, Hui Han MD†, Myra A. Wheaton MD*, James F. Mayhew MD*, Bindi Patel MD*, George Mychaskiw DO*
*Department of Anesthesiology, †Department of Medicine, University of Mississippi Medical Center

Objective:
The purpose of this study was to investigate the association of obesity with the difficulty of endotracheal intubation in adult patients who required rapid sequence intubation (RSI).
Methods:
After approval from our IRB, all anesthesia records of patients’ who had undergone general endotracheal anesthesia from October 2003 through March 2004 were reviewed. Only those records that recorded a RSI with age 18 and above were included. The exclusion criteria included (1) missing major information such as age, gender, weight, height, RSI status, and intubation score; (2) patients with a history of difficult intubation; (3) patients whose BMI was less than 19.0; and (4) obstetrical patients. Scores of airway difficulty were defined as: 0 - no difficulty; 1- mild difficulty with only 2 or 3 attempts; 2 - moderate difficulty with more than 3 attempts; and 3 - severe difficulty with multiple attempts and use of adjunct devices. Patients were grouped according to the BMI values: normal weight (19.0-24.9), overweight (25.0-29.9) and obesity (> 30). Polychotomous logistic regression was used to compare the patients with different difficulty airway scores in each group. Final results were adjusted by age, gender, ASA status, and emergency status. All the data were transferred and analyzed using SAS (version 8.0). P<0.05 was defined as statistical significance.
Results:
There were 731 patients that fulfilled our criteria. Among them, there were 163 patients in the normal weight group, 180 patients in the overweight group, and 388 patients in the obesity group. 86.6% of our patients had an airway difficulty score of 0. Results of the airway difficulty score assigned by BMI were shown in table 2. When compared to the normal weight group, the incidence of an airway difficulty score of 0 was lower in the overweight group and the obesity group (p < 0.01). In the overweight group and the
obesity group, the incidence with an airway difficulty score of 1 was significantly higher (p < 0.05) when compared to the normal weight group. There was no statistical difference in the groups with higher (2 or greater) airway difficulty scores.
Conclusion:
Our data suggests that both overweight and obesity patients may have an increased incidence of difficult tracheal intubation when using a rapid sequence technique. However, our study size was not big enough to determine the absolute association of difficult tracheal intubations in both adult overweight and obesity patients.

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