Effect of Manual Caudal and Downward Displacement of Lower Cervical Adipose Tissue on Laryngoscopic Grade of Patients with Morbid Obesity

BACKGROUND: The prevalence of obesity has substantially increased all over the world in the past decades and anesthesiologists more commonly encounter these patients. Excess cervical adipose tissues can result in the narrowing of the pharyngeal opening and affect laryngoscopic grade. OBJECTIVES: To evaluate the effect of manual caudal and cervical displacement of cervical adipose tissue on laryngoscopic view of morbid obese patients. METHODS: A total of 70 patients with a BMI ≥ 35 were enrolled in this study. All patients were placed in the ramp position. Manual caudal and downward displacement of cervical adipose tissue was performed by an anesthesiologist. Laryngoscopy was performed by an anesthesiologist before and after manual displacement. The anesthesiologist was blinded as we had drawn a curtain, therefore, he could not recognize if the maneuver was being performed or not. Thyromental distance, upper lip bite test, hyomental distance, and BMI were recorded for all patients. RESULTS: Age, weight, and BMI didn’t have any significant relation with difficult intubation. There was a significant relationship between difficult intubation and thyromental distance, upper lip bite test, Mallampati score, and hyomentaldistance (P: 0.01, 0.04, 0.001, and 0.005, respectively). Cormack-Lehane grade significantly improved after the maneuver (P: 0.001). CONCLUSIONS: Preparation and appropriate management of airway is very important for morbid obese patients. Manual caudal and downward displacement of adipose tissue has a significant effect on the improvement of laryngoscopic view in morbid obese patients. Therefore, ramped position or manual and caudal displacement of chest wall fat tissue can be added to "standard" preoperative airway assessment.