STOP-Bang and prediction of difficult airway in obese patients

Aug 2, 2014Journal of clinical anesthesia

STOP-Bang questionnaire and predicting breathing problems during airway management in obese patients

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Abstract

A high STOP-Bang score (≥ 3) is associated with a significantly increased risk of difficult airway in obese patients.

Patients with a high STOP-Bang score demonstrated a higher risk for difficult airway compared to those with a low score.
Obese patients who had a previous diagnosis of obstructive sleep apnea (OSA) also exhibited increased airway difficulties.
The findings suggest that using the STOP-Bang questionnaire could help identify obese patients at risk for complications during anesthesia.
Evaluation of OSA status in surgical patients may benefit from administering the STOP-Bang questionnaire.

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STUDY OBJECTIVE: To determine if a high score (≥ 3) on the STOP-Bang screening questionnaire for obstructive sleep apnea (OSA) predicts whether obese patients are at high risk for OSA and increased risk of difficult airway.

DESIGN: Prospective, questionnaire-based clinical assessment.

SETTING: University-affiliated hospital.

PATIENTS: 127 ASA physical status 2 and 3 patients, who were scheduled for elective bariatric surgery.

INTERVENTIONS: Patients were allocated to three groups. Group 1 patients had a previous history of OSA, Group 2 patients had no history of OSA but did have a high STOP-Bang score (≥ 3), and Group 3 patients had no history of OSA but did have a low STOP-Bang score (< 3). Groups 2 and 3 only were assessed using the STOP-Bang questionnaire. After induction and intubation of the patient, an anesthesiologist who was blinded to the three study group allocations completed an airway questionnaire on the three study groups.

MEASUREMENTS: The frequency of difficult airway, difficult mask ventilation with or without muscle relaxation, poor visualization of the vocal cords, difficulty in blade insertion, and difficult intubation were compared.

MAIN RESULTS: The group of patients with high STOP-Bang scores (Group 2) and those patients previously diagnosed with OSA (Group1) showed a higher risk for difficult airway than the patients with low STOP-Bang scores (Group 3; P < 0.001).

CONCLUSION: The STOP-Bang score may be used as an effective predictor of difficult airway in obese patients. Obese surgical patients with unknown/undiagnosed OSA status should be evaluated using the STOP-Bang questionnaire score.

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STOP-Bang and prediction of difficult airway in obese patients

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