Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

doi:10.1590/S0034-70942011000100004

Artigo Científico

Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

Reevaluation of the airways of obese patients undergone bariatric surgery after reduction in body mass index

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

http://dx.doi.org/10.1590/S0034-70942011000100004 Braz J Anesthesiol, vol.61, n1, p.35-40, 2011

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: A dificuldade na intubação traqueal é causa de mortalidade em anestesiologia e pode estar relacionada à obesidade. Diagnosticar uma intubação difícil contribui para o êxito da abordagem da via aérea, mas os parâmetros preditores de intubação difícil não estão bem estabelecidos. A classificação de Mallampati, a distância interincisivos, a circunferência do pescoço, a distância tireomentoniana e a presença da síndrome da apneia obstrutiva do sono são parâmetros que podem indicar uma intubação difícil. O tratamento cirúrgico da obesidade proporciona redução do índice de massa corpórea (IMC), com estabilização por volta de 2 anos. O objetivo desta pesquisa foi reavaliar os parâmetros descritos com os valores pré-cirúrgicos. MÉTODO: Cinquenta e um pacientes de ambos os sexos foram avaliados no período pré-operatório quanto a IMC, classificação de Mallampati, circunferência do pescoço, distância interincisivos, distância tireomentoniana e grau da síndrome de apneia obstrutiva do sono por meio da polissonografia. Após dois anos de cirurgia e redução do IMC < 35 kg.m-2, os preditores de intubação difícil foram reavaliados por outro médico anestesiologista com conhecimento do IMC prévio. Foram excluídos nove pacientes. Executou-se reavaliação dos parâmetros supracitados e, para os que não realizaram nova polissonografia, aplicou-se a escala de sonolência de Epiworth. RESULTADOS: Quarenta e dois pacientes foram reavaliados e mostraram redução do IMC e da circunferência do pescoço e aumento das distâncias interincisivos e tireomentoniana. Apenas um paciente apresentou redução na escala de Mallampati e somente quatro realizaram a polissonografia. CONCLUSÕES: A redução do IMC proporciona aumento das distâncias interincisivos e tireomentoniana e redução da circunferência do pescoço. O Mallampati permanece inalterado.

Palavras-chave

DOENÇA, Obesidade, INTUBAÇÃO TRAQUEAL, SISTEMA RESPIRATÓRIO, TÉCNICAS DE MEDIÇÃO, Índice de Massa Corporal

Abstract

BACKGROUND AND OBJECTIVES: Difficulty intubating is a cause of mortality in anesthesiology and it can be related to obesity. The diagnosis of difficult intubation contributes for successful airways management. However, parameters that predict difficult airways are not well established. Mallampati classification, the interincisor gap, neck circumference, thyromental distance, and the presence of obstructive sleep apnea, are parameters that can indicate difficult intubation. Surgical treatment of obesity provides reduction in body mass index (BMI) with stabilization after about 2 years. The objective of the present study was to reevaluate the parameters described above and compare them with pre-surgical values. METHODS: The BMI, Mallampati classification, neck circumference, interincisor gap, thyromental distance, and the degree of obstructive sleep apnea in polysomnography were evaluated in 51 patients of both genders in the preoperative period. Two years after the surgery and reduction of the BMI to < 35 kg.m-2, predictor factors of difficult airways were reevaluated by another anesthesiologist who knew the patients' BMI before surgery. Nine patients were excluded. The new reevaluation was performed, and for those who did not have another polysomnography the somnolence scale of Epiworth was applied. RESULTS: Forty-two patients were reevaluated. They showed a reduction in BMI and neck circumference, and an increase in both interincisor gap and thyromental distance. Only one patient showed a reduction in Mallampati scale, and only 4 patients performed polysomnography. CONCLUSIONS: Reduction of the BMI allows for an increased interincisor gap, thyromental distance, and reduction in neck circumference. Mallampati classification remains the same.

Keywords

Obesity, Body Mass Index, Airway Management, Intubation

Referências

Juvin P, Lavaut E, Dupont H. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595-600.

Rosenblatt WH. Decision making in airway evaluation. ASA Refresher Courses in Anesthesiol. 2004;32:179-186.

Rosenblatt WH. Preoperative planning of airway management in critical care patients. Crit Care Med. 2004;32(^s4):186-192.

Mallampati SR, Gatt SP, Gugino LD. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429-434.

Benumof JL. The ASA difficult airway algorithm: new thoughts and considerations. . 1999;134:1-7.

Brodsky JB. Anesthesia for bariatric surgery. ASA Refresher Courses Anesthesiol. 2005;33:49-63.

Pieracci FM, Barie PS, Pomp A. Critical care of the bariatric patient. Crit Care Med. 2006;34:1796-1804.

Luce JM. Respiratory complications of obesity. Chest. 1980;78:626-631.

Ogunnaike BO, Jones SB, Jones DB. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95:1793-1805.

Mullen JT, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg. 2009;250:166-172.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540- 545.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-1277.

Arné J, Descoins P, Fusciardi J. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a multivariate risk index. Br J Anaesth. 1998;80:140-146.

Cass NM, James NR, Lines V. Difficult direct laryngoscopy complicating intubation for anaesthesia. Br Med J. 1956;1:488-489.

Chou H-C, Wu T-L. Mandibulohyoid distance in difficult laryngoscopy. Br J Anaesth. 1993;71:335-339.

Chung F, Crago RR. Sleep apnoea syndrome and anaesthesia. Can Anaesth Soc J. 1982;29:439-445.

Patil VU, Stchling LC, Zauder HL. Fiberoptic Endoscopy in Anesthesia. 1983.

Davies RJO, Stradling JR. The relationship between neck circumference, radiographic pharyngeal anatomy, and obstructive sleep apnoea syndrome. Eur Respir J. 1990;3:509-514.

Hoffstein V, Szalai JP. Predictive value of clinical features in diagnosing obstructive sleep apnoea. Sleep. 1993;16:118-122.

Auler Jr JOC, Giannini CG, Saragiotto DF. Desafios no manuseio perioperatório de pacientes obesos mórbidos: como prevenir complicações. Rev Bras Anestesiol. 2003;53:227-236.

Ashwell M, Chinn S, Stalley S. Female fat distribution: a simple classification based on two circumference measurements. Int J Obes. 1982;6:143-152.

Abraham S, Johnson CL. Prevalence of severe obesity in adults in the United States. Am J Clin Nutr. 1980;33:364-369.

Whittle AT, Marshall I, Mortimore IL. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax. 1999;54:323-328.

Ezri T, Gewürtz G, Sessler DI. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111-1114.

Gonzalez H, Minville V, Delanoue K. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg. 2008;106:1132-1136.

Baker PA, Depuydt A, Thompson JM. Thyromental distance measurement: fingers don't rule. Anaesthesia. 2009;64:878-882.

Shiga T, Wajima Z, Inoue T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429-437.

Wilson ME, Spiegelhalter D, Robertson JA. Predicting difficult intubation. Br J Anaesth. 1988;61:211-216.

Randell T. Prediction of difficult intubation. Acta Anaesthesiol Scand. 1996;40:1016-1023.

Janssens M, Hartstein G. Management of difficult intubation. Eur J Anaesthesiol. 2001;18:3-12.

Lee A, Fan LT, Gin T. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867-1878.

Loadsman JA, Hillman DR. Anaesthesia and sleep apnoea. Br J Anaesth. 2001;86:254-266.

Benumof JL. Obstructive sleep apnea in adult obese patients: implications for airway management. Anesthesiol Clin North Am. 2002;20:789-811.

Frappier J, Guenoun T, Journois D. Airway management using the intubating laryngeal mask airway for the morbidly obese patient. Anesth Analg. 2003;96:1510-1515.

Reavaliação da via aérea do paciente obeso submetido à cirurgia bariátrica após a redução do índice de massa corpórea

Reevaluation of the airways of obese patients undergone bariatric surgery after reduction in body mass index

José Admirço Lima Filho; Eliana Marisa Ganem; Bruno Gardélio Pedreira de Cerqueira

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol