FREQUENCY OF DIFFICULT INTUBATION AND FACE MASK VENTILATION IN PATIENTS UNDERGOING BARIATRIC SURGERY

Abstract

Background

Airway management in obese patients undergoing bariatric surgery is particularly challenging because of altered upper airway anatomy, reduced functional residual capacity, and rapid oxygen desaturation following induction of anesthesia. These physiological and anatomical changes increase the risk of difficult intubation (DI) and difficult mask ventilation (DMV), which are major contributors to anesthesia-related morbidity and mortality. Identifying the frequency of difficult airway in this population is important for better perioperative planning and improved patient safety.

Objective

To determine the frequency of difficult intubation and face mask ventilation in patients undergoing bariatric surgery.

Methods

This prospective cross-sectional study was conducted in the Department of Anesthesiology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, over six months. A total of 231 patients aged 20–65 years, classified as ASA I or II and scheduled for bariatric surgery under general anesthesia, were included using consecutive non-probability sampling. Difficult intubation was defined as Cormack–Lehane grade III or IV during direct laryngoscopy. Difficult face mask ventilation was defined as Han grade III or IV. Preoperative airway assessment included BMI, mouth opening, thyromental distance, and neck circumference. Data were analyzed using SPSS version 25, and p ≤ 0.05 was considered statistically significant.

Results

The mean age was 41.8 ± 9.6 years, and mean BMI was 38.7 ± 4.5 kg/m². Females constituted 55.8% of patients. Difficult intubation occurred in 14 patients (6.1%), while difficult face mask ventilation was observed in 46 patients (19.9%). Increased neck circumference and BMI ≥ 40 kg/m² showed significant association with difficult airway (p < 0.05).

Conclusion

Difficult intubation and face mask ventilation are relatively common in bariatric patients. Comprehensive preoperative airway assessment is essential to anticipate and manage airway challenges effectively. Special attention should be given to patients with increased neck circumference and higher BMI, as they are at greater risk of airway difficulty. Early preparation of advanced airway equipment and experienced personnel may further reduce perioperative complications and improve clinical outcomes.