Airway management in bariatric surgery patients, our experience in Qatar: A prospective observational cohort study

Background: Obesity has always been considered a criterion of difficult airway management, and many authors have tackled this subject. We are presenting our experience in airway management in obese patients undergoing bariatric surgery in Qatar and comparing the results with previous studies. Objective: The primary objective of this study was to explore the relationship between difficult mask ventilation and difficult intubation. The secondary objective was to identify other factors that may play a role in either difficulty such as gender, associated comorbidities, and the skill and experience of anesthetists. Design: This study was a prospective observational cohort study. Sample: A total of 401 patients were selected for various elective bariatric surgery in Hamad General Hospital, including 130 males and 271 females with an average body mass index(BMI) of 46.03 kg m^- 2. Results: We used Pearson Chi-Square and Yates corrected Chi-square statistical tests in our statistical analysis. Neck circumference had a p value of 0.001 in both genders. The male gender had a p value of 0.052 and 0.012 in mask ventilation and difficult intubation, respectively. The Mallampati score had a p value of 0.56 and 0.006 in mask ventilation and intubation, respectively. In general, neck circumference, Mallampati score, gender, obstructive sleep apnea, and diabetes mellitus had greater negative effects on airway management than BMI alone. Conclusion: It was hard to intubate 25% of patients who had difficult mask ventilation (DMV). All DMV and 20 out of 23 of difficult intubation patients were in the high BMI group ( ≥ 40). Neck circumference, Mallampati score, and male gender were major independent factors; however, other factors, such as obstructive sleep apnea, and diabetes mellitus, should be kept in mind as additional risks.