The Role of Anthropometric Measurements and Ultrasonograpic Suprasternal Adipose Tissue Thickness

Predicting Difficult Intubation in Obese Patients: The Role of Anthropometric Measurements and Ultrasonograpic Suprasternal Adipose Tissue Thickness

Prediction of difficult preoperative intubation in obese patients and completion of preparations for difficult intubation both reduce the risk of repeated intubation and prevent complications.

In this study, the investigators aimed to evaluate whether anthropometric measurements are superior in defining difficult preoperative airways.

Study Overview

• Status: Completed
• Conditions: Obesity; Anesthesia; Intubation; Difficult or Failed
• Intervention / Treatment: Device: Difficult Intubation; Device: Not Difficult Intubation

Detailed Description

The World Health Organization (WHO) defines obesity, the incidence of which has increased significantly worldwide and is one of the important causes of difficult airway in terms of anesthesia, as obesity when the body mass index (BMI) is above 30. Access to the upper airway is difficult in obese patients, in whom excessive adipose tissue accumulates in the breast, neck, chest, and abdomen. Determining preoperative difficult intubation parameters in obese patients and entering the case preparation both reduce the risk of repeated intubation and prevent intraoperative and postoperative complications.

However, there are still insufficient tests to predict difficult intubation. Many studies have shown that multiple factors such as Mallampati score, high body mass index (BMI), increased neck circumference, and the ratio of neck circumference to thyromental distance are predictors of difficult intubation in obese patients. The introduction of ultrasonography into daily use has led to the use of ultrasonographic parameters in predicting difficult intubation and laryngoscopy. In this study, the investigators aimed to evaluate whether ultrasonography is useful in defining difficult preoperative airways, in addition to anthropometric measurements.

• Study Type: Observational
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey, 06800
    • Ankara Bilkent City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

40 patients between the ages of 18-60 years, ASA 1-3, BMI ≥30 kg/m2, ASA 1-3, scheduled for elective abdominal surgery under general anesthesia.

Description

Inclusion Criteria:

• 18-60 years
• ASA 1-3
• BMI ≥30 kg/m2
• ASA 1-3
• Scheduled for elective abdominal surgery under general anesthesia

Exclusion Criteria:

• <18 and >60 years
• ASA>3
• BMI<30

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Difficult Intubation; Abdominal circumference, waist circumference, arm circumference, distance between incisions,TMD and SMD measurements, Mallampati test, Wilson score, and suprasternal subcutaneous adipose tissue thickness were measured and recorded. ECG, SBP and DBP, and SpO2 monitoring were performed. Pre-oxygenation was performed using a 100% oxygen face mask for 3 min before the induction of anesthesia. Induction of anesthesia was achieved with IV 1 mg/kg lidocaine, 0.125 mcgr/kg fentanyl, 2 mg/kg propofol, and 0.6 mg/kg rocuronium bromide. After 2 min of adequate muscle relaxation, the patient was intubated with an endotracheal tube of appropriate diameter. Cormack-Lehane score was evaluated during laryngoscopy. Patients with more than 3 intubation attempts by an experienced anesthesiologist were considered difficult to intubate. In maintenance, 0.1 mcg/kg/h remifentanil was administered in sevoflurane O2-air mixture. Age, sex, body weight,BMI, and ASA scores were recorded.	Device: Difficult Intubation; Noted for each patient.; Other Names: ASA; BMI; Age; Arm circumference; TMD; SMD; Distance between incisions; Abdominal circumference; Waist circumference; Suprasternal adipose tissue thickness; Mallampati; Cormack-Lehane score; Wilson score; Device: Not Difficult Intubation; Noted for each patient.; Other Names: ASA; BMI; Age; Arm circumference; TMD; SMD; Distance between incisions; Abdominal circumference; Waist circumference; Suprasternal adipose tissue thickness; Mallampati; Cormack-Lehane score; Wilson score
Not Difficult Intubation; Abdominal circumference, waist circumference, arm circumference, distance between incisions,TMD and SMD measurements, Mallampati test, Wilson score, and suprasternal subcutaneous adipose tissue thickness were measured and recorded. ECG, SBP and DBP, and SpO2 monitoring were performed. Pre-oxygenation was performed using a 100% oxygen face mask for 3 min before the induction of anesthesia. Induction of anesthesia was achieved with IV 1 mg/kg lidocaine, 0.125 mcgr/kg fentanyl, 2 mg/kg propofol, and 0.6 mg/kg rocuronium bromide. After 2 min of adequate muscle relaxation, the patient was intubated with an endotracheal tube of appropriate diameter. Cormack-Lehane score was evaluated during laryngoscopy. Patients with more than 3 intubation attempts by an experienced anesthesiologist were considered difficult to intubate. In maintenance, 0.1 mcg/kg/h remifentanil was administered in sevoflurane O2-air mixture. Age, sex, body weight,BMI, and ASA scores were recorded.	Device: Difficult Intubation; Noted for each patient.; Other Names: ASA; BMI; Age; Arm circumference; TMD; SMD; Distance between incisions; Abdominal circumference; Waist circumference; Suprasternal adipose tissue thickness; Mallampati; Cormack-Lehane score; Wilson score; Device: Not Difficult Intubation; Noted for each patient.; Other Names: ASA; BMI; Age; Arm circumference; TMD; SMD; Distance between incisions; Abdominal circumference; Waist circumference; Suprasternal adipose tissue thickness; Mallampati; Cormack-Lehane score; Wilson score

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Suprasternal Adipose Tissue Thickness	It is predicted that it may indicate difficult intubation.	within 10 minutes before going into surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Abdominal circumference	Noted for each patient.	within 10 minutes before going into surgery
Waist circumference	Noted for each patient.	within 10 minutes before going into surgery
Arm circumference	Noted for each patient.	within 10 minutes before going into surgery
Distance between incisions	Noted for each patient.	within 10 minutes before going into surgery
Thyromental distance measurement	Noted for each patient.	within 10 minutes before going into surgery
Sternomental distance measurement	Noted for each patient.	within 10 minutes before going into surgery
Mallampati Score	Noted for each patient.	within 10 minutes before going into surgery(class 1-4; 1 means good and 4 means bad)
Wilson score	Noted for each patient.	within 10 minutes before going into surgery(grade 0-10; 0 means good, 10 means bad)
Cormack-Lehane score	Noted for each patient.	1. minute after intubation(class 1-4; 1 means good and 4 means bad)
Age	Noted for each patient.	within 10 minutes before going into surgery
Sex	Noted for each patient.	within 10 minutes before going into surgery
ASA	Noted for each patient.	within 10 minutes before going into surgery(grades 1-6; 1 means good and 6 means bad)
BMI	Noted for each patient.	within 10 minutes before going into surgery

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: Ayça Tuba Dumanlı Özcan, Ankara Bilkent City Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): January 1, 2022
• Study Completion (Actual): January 1, 2024

Study Registration Dates

• First Submitted: June 10, 2024
• First Submitted That Met QC Criteria: June 10, 2024
• First Posted (Actual): June 13, 2024

Study Record Updates

• Last Update Posted (Actual): June 14, 2024
• Last Update Submitted That Met QC Criteria: June 13, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: Difficult Intubation

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No