Intubation Difficulties in Obese Patients

In Response:

We acknowledge the comments of van Zundert and Lee¹ concerning our recent article.²

As stated, difficult intubation was assessed using the intubation difficulty scale developed by Adnet et al.³ on the basis of seven variables associated with difficult intubation recorded by the anesthetist in charge of the patient. We choose intubation difficulty scale because it is an objective and validated score including intubations conditions.

The video-laryngoscope is one tool among the plethora of tools available for difficult intubation but assessment of its risk/benefit in the difficult intubation algorithm is still unclear.

We disagree with van Zundert and Lee concerning the usefulness of bedside tests. Even if they are not highly specific in predicting difficult intubation, we believe they are essential and obligatory in order to reduce the likelihood of morbidity associated with difficult airway management.

Yes, “we can’t change the physiognomy of a patient.” But the “endless efforts assessing factors which may or may not predict a difficult tracheal intubation,” must be the first step in assessment of the airway for all patients.

Vincent Minville, MD

Hélène Gonzalez, MD

Olivier Fourcade, MD, PhD

Department of Anesthesiology and Intensive Care

University Hospital of Toulouse

Toulouse, France

[email protected]