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Increased body mass index per se is not a predictor of difficult laryngoscopy

[Un indice de masse corporelle élevé n’est pas, en soi, un prédicteur de laryngoscopie difficile]

Tiberiu Ezri, MD^*, Beniamin Medalion, MD, Marian Weisenberg, MD^*, Peter Szmuk, MD, R. David Warters, MD and Ilan Charuzi, MD

^* From the Departments of Anesthesia,
Cardiothoracic Surgery, and General Surgery "B",
Wolfson Medical Center, Holon, Affiliated with Sackler School of Medicine, Tel Aviv, Israel; and
the Department of Anesthesiology, University of Texas Medical School at Houston, Texas, USA.

Address correspondence to: Dr. Tiberiu Ezri, Director, Department of Anesthesia, Wolfson Medical Center, Holon, Israel. Phone: 972-3-5028229; Fax: 972-8-9475188; E-mail: tezri{at}netvision.net.il

Purpose: We investigated the association between morbid obesity and difficult laryngoscopy (DL).

Methods: In a prospective, controlled study we evaluated the impact of different variables on the prediction of DL in 200 morbidly obese (study group-SG), and 1,272 non-obese (control group-CG) patients undergoing elective surgery. Variables assessed included age, sex, body mass index (BMI), protruding, loose, and missing upper teeth, thyro-mental distance, temporo-mandibular joint (TMJ) function, neck extension, and Mallampati class. A Cormack grade III or IV was considered DL.

Results: The SG patients were younger (P < 0.000), there were more females in the SG (P < 0.000) and more in the SG had teeth problems (P = 0.026). More patients in the SG (10% vs 1%), had obstructive sleep apnea (P < 0.001) with 90% of them in the SG having a grade III laryngoscopy. High BMI did not affect the laryngoscopy difficulty (P = 0.56). Multivariable regression analysis revealed that morbid obesity, increased age, male sex, pathology of TMJ, and higher Mallampati class, were independent predictors of DL. When interaction between the predictors and the group was added to the multivariable model, the SG was no longer a predictor by itself, rather its association with abnormal upper teeth turned to be significant for prediction of DL.

Conclusions: Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL. The magnitude of BMI had no influence on difficulty with laryngoscopy.

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