Study: BMI, hidden tumors complicate intubation

Editor's Note

Subtle risk factors—such as low BMI and hidden tumors—could lead to unexpected airway management difficulties, according to research published on March 17 in Nature: Scientific Reports.

The case-control study analyzed 672 surgical patients who required endotracheal intubation between 2015 and 2020. Researchers compared 168 patients who experienced difficult intubation—defined as requiring at least three attempts—with 504 matched controls. Prior airway issues and abnormal facial features (often associated with syndromes such as Down syndrome) pose the highest risk for anticipated difficulty, the authors write, while low BMI and unrecognized tumors increase the likelihood of unanticipated challenges.

Specifically:

• BMI greater than 15 kg/m2 increased odds of difficult intubation by 4.6 times.
• Airway/neck/oral deformity increased odds by 2.1 times.
• Intraoral, airway, or thyroid tumors increased odds by 2.4 times.

This study highlights the need for thorough preoperative assessment, particularly in patients with unrecognized airway abnormalities, the researchers write.