Background: Difficult airway in bariatric patients presents significant challenges during anesthesia, impacting patient safety and surgical outcomes. This study aims to estimate the incidence of difficult airway in bariatric patients undergoing surgery. Materials and Methods: This prospective observational cohort study will be conducted in a single center. Patients over 18 years with a BMI ≥ 30 kg/m2 undergoing bariatric surgery and requiring intubation will be included. Data will be collected on patient demographics, clinical characteristics, and intubation outcomes. The primary outcome is the occurrence of difficult airway, defined by specific criteria including intubation difficulty and the need for alternative airway management techniques. Secondary outcomes include complications related to airway management and overall surgical outcomes. A total of 1290 patients will be included in the study to estimate the incidence of difficult airway within a confidence of 3%. Conclusions: Difficult airway management in bariatric patients is relatively common and is influenced by specific patient factors. The findings of this study will mainly allow the estimation of difficult airway incidence in patients with bariatric surgery under the new clinical definitions.
Study Type
OBSERVATIONAL
Enrollment
1,290
Aiway management procedure involving the Insertion of an orotracheal cannula through the oropharynx.
Centro Medico Bariatrico
Tijuana, Estado de Baja California, Mexico
Incidence of difficult airway
Cumulative incidence (expressed as a percentage), according to the American Society of Anesthesiologists 2022 definition of difficult airway (anticipated or unanticipated difficulty or failure is experienced by a physician trained in anesthesia care, including but not limited to one or more of the following: facemask ventilation, laryngoscopy, ventilation using a supraglottic airway, tracheal intubation, extubation, or invasive airway).
Time frame: Day 1
Incidence of severe hypoxia
Cumulative incidence (expressed as percentage) of severe hypoxia, defined as a peripheral blood oxygen saturation (SpO2) lower than 80% during advanced airway management.
Time frame: Day 1
Incidence of cardiovascular collapse
Cumulative incidence (expressed as percentage) of cardiovascular collapse, defined as any of the following events within 30 minutes from induction to surgical incision: * Systolic blood pressure lower than 65 mmHg. * Dyastolic blood pressure ower than 90 mmHg for more than 15 minutes * Unplanned need for vasopressors or fluid loading greater than; 15 ml/kg to maintain target blood pressure.
Time frame: Day 1
Incidence of minor adverse events
Cumulative incidence (expressed as percentage) of minor adverse events, including: * Moderate hypoxia (SpO2 lower than 93%), * Airway injury, * Clinically relevant bleeding, * Oral aspiration of gastric contents, * Dental injury, * Lip injury.
Time frame: Day 1
Incidence of Difficult Facemask Ventilation
Cumulative incidence (expressed as a percentage), according to the American Society of Anesthesiologists 2022 definition of Difficult Facemask Ventilation (It is not possible to provide adequate ventilation, because of one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas.). For operationalization, successful face mask ventilation with 2 hands will be consigned as the reference (No difficult face mask ventilation), whereas face mask ventilation attempts with 4 or 6 hands will be considered as the presence of difficult face mask ventilation.
Time frame: Day 1
Incidence of Difficult or Failed Tracheal Intubation
Cumulative incidence (expressed as a percentage), according to the American Society of Anesthesiologists 2022 definition of Difficult or Failed Tracheal Intubation (Tracheal intubation requires multiple attempts or tracheal intubation fails after multiple attempts.). For operationalization, more than 1 attempt will be considered as Difficult or Failed Tracheal Intubation.
Time frame: Day 1
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