The Relationship of Anthropometric Indices and Hemodynamic Changes after Laryngoscopy

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Anesthesiologist, Fellow of Intensive Care Unit (ICU), Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

5 Nurse, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Laryngoscopy and endotracheal intubation are critical procedures and if the anthropometric indices of the patient leading to difficult intubation are not considered before the procedure, it can be accompanied by serious complications. One of the most practical concepts suggested about difficult intubation, is Cormack and Lehane criteria used in most medical centers. However, there is not any valuable study demonstrate the effect of anthropometric indices in difficult intubation and the immediate prediction of its complications. This study aimed to evaluate the correlation of anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation.Methods: This descriptive-analytic study was carried out in 2012 in Kashani hospital, Isfahan, Iran. 130 patients with fulfilling inclusion criteria were entered the study. The recorded data included age, weight, height, neck circumference, waist-to-hip ratio and body mass index. The difficulty of intubation was assessed when the patient was completely unconscious. The predictive role of obesity indices in difficult intubation and the cardiovascular changes after intubation was assessed using receiver operating characteristic (ROC) curve.Findings: The best cut-off point for body mass index (BMI) was 26.56; according to this cut-off point, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of BMI were 100, 38.84, 10.8 and 91.1 percent, respectively. The best cut-off point for neck circumference was 38; according to this cut-off point, the sensitivity, specificity, PPV and NPV of neck circumference were 7.85, 2.28, 2.45, 1.91 percent, respectively.Conclusion: BMI, neck circumference and waist-to-hip ratio are valuable in assessing difficult intubation and their value is mostly due to NPV. Therefore, we can achieve a significant NPV and sensitivity in assessment of difficult intubation by considering all these indices.

Keywords


  1. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 2004; 99(2): 607-13, table.
  2. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995; 82(2): 367-76.
  3. Mort TC. Unplanned tracheal extubation outside the operating room: a quality improvement audit of hemodynamic and tracheal airway complications associated with emergency tracheal reintubation. Anesth Analg 1998; 86(6): 1171-6.
  4. Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med 1998; 31(3): 325-32.
  5. Tayal VS, Riggs RW, Marx JA, Tomaszewski CA, Schneider RE. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med 1999; 6(1): 31-7.
  6. Redan JA, Livingston DH, Tortella BJ, Rush BF. The value of intubating and paralyzing the suspected head injured patient in the emergency room. Journal Of Trauma 1989; 29(12): 1730-4.
  7. Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 2008; 106(4): 1132-6, table.
  8. Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54(2): 254-60.
  9. Gurulingappa, Aleem MA, Awati MN, Adarsh S. Attenuation of Cardiovascular Responses to Direct Laryngoscopy and Intubation-A Comparative Study Between iv Bolus Fentanyl, Lignocaine and Placebo(NS). J Clin Diagn Res 2012; 6(10): 1749-52.
  10. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61(2): 211-6.
  11. Ben-Noun LL, Laor A. Relationship between changes in neck circumference and cardiovascular risk factors. Exp Clin Cardiol 2006; 11(1): 14-20.
  12. Ben-Noun L, Sohar E, Laor A. Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res 2001; 9(8): 470-7.
  13. Ashwell M, Cole TJ, Dixon AK. Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J (Clin Res Ed) 1985; 290(6483): 1692-4.
  14. Wing RR, Jeffery RW, Burton LR, Thorson C, Kuller LH, Folsom AR. Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. Am J Clin Nutr 1992; 55(6): 1086-92.
  15. Haffner SM, Stern MP, Hazuda HP, Pugh J, Patterson JK. Do upper-body and centralized adiposity measure different aspects of regional body-fat distribution? Relationship to non-insulin-dependent diabetes mellitus, lipids, and lipoproteins. Diabetes 1987; 36(1): 43-51.
  16. Ben-Noun LL, Laor A. Relationship between changes in neck circumference and changes in blood pressure. Am J Hypertens 2004; 17(5 Pt 1): 409-14.
  17. Ben-Noun L, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res 2003; 11(2): 226-31.