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STOP-Bang and prediction of difficult airway in obese patients

This prospective, questionnaire-based clinical assessment was conducted at a university-affiliated hospital in Detroit, Mich, to determine if a high score (≥3) on the STOP-Bang screening questionnaire for obstructive sleep apnea (OSA) predicts whether morbidly obese patients (body mass index ≥35 kg/m) are at high risk for OSA and increased risk of difficult airway. One hundred twenty-seven morbidly obese American Society of Anesthesiologists physical status 2 and 3 patients, who were scheduled for elective bariatric surgery, were included. Patients were allocated to 1 of 3 groups. Group 1 patients had a known 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 and had a low STOP-Bang score (<3). Groups 2 and 3 were assessed using only the STOP-Bang questionnaire. After induction and intubation of the patients, an experienced anesthesiologist who was blinded to the 3 study group allocations completed an airway questionnaire on the 3 study groups. 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. Groups 1 and 2 patients were identified as being at higher risk for having a difficult airway than the patients with low STOP-Bang scores (group 3). The investigators, therefore, concluded that the STOP-Bang score may be used as a helpful predictor of difficult airway in morbidly obese patients. It would seem that morbidly obese surgical patients with unknown/ undiagnosed OSA status would benefit from evaluation using the STOP-Bang questionnaire.