Preoperative video laryngoscopic examination for difficult intubation in obese patients.

BACKGROUND: Anatomical and physiological changes often observed in obese patients increase the risk of difficult tracheal intubation (DTI). In this study, we explored the potential of video-assisted laryngoscopy to prospectively predict DTI in obese patients. MATERIAL AND METHODS: Patients scheduled for general anesthesia with a body mass index (BMI) higher than 30 were included in the study. The El-Ganzouri risk index (EGRI) was calculated during routine preoperative bedside evaluations. An EGRI of ≥ 4 was considered indicative of DTI. Following the application of a local anesthetic agent to the airway, the percentage of glottic opening (POGO) score was obtained using preoperative video laryngoscopy. In the POGO score, visibility of 50% or less of the glottic opening was considered indicative of difficult intubation. Intubation difficulties were assessed using the intubation difficulty scale (IDS), with an IDS score > 5 considered indicative of difficult intubation. RESULTS: The study included 104 patients with an average BMI of 36.9 ± 4.8. According to the IDS, the incidence of DTI was 30.8% (n = 32). The POGO score displayed a significantly higher positive predictive value and sensitivity compared to the EGRI (p < 0.0001 for both). The ROC analysis showed better discriminative performance for the POGO score than for the EGRI (AUC: 0.868 vs. 0.436; p < 0.001). The preoperative POGO score was correlated with the IDS (r = 0.710, p < 0.001). CONCLUSION: Our findings suggest that the POGO score obtained during preoperative video-assisted laryngoscopy is associated with difficult tracheal intubation in obese patients.