Multiple intubation attempts in obese patients during oral and maxillofacial surgery: analysis of risk factors

doi:10.19438/j.cjoms.2026.02.008

Abstract

Abstract: PURPOSE: To investigate the risk factors for increased tracheal intubation attempts in obese patients undergoing oral and maxillofacial surgery. METHODS: A total of 1 425 obese patients (BMI ≥ 28 kg/m²) who underwent general anesthesia for oral and maxillofacial surgery in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to July 2024 were enrolled retrospectively. The patients' medical history, airway anatomical parameters and data related to anesthetic induction were collected. According to the number of tracheal intubation attempts, the patients were divided into the single-attempt success group(n=1 394) and the multiple-attempt intubation group (n=31). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for increased number of tracheal intubation attempts. RESULTS: Multivariate analysis revealed that limited neck mobility (OR=4.71, 95%CI: 1.03-15.44, P=0.021) and maxillary protrusion(OR=11.999, 95%CI: 1.682-55.128, P=0.003) were independent risk factors for multiple intubation attempts. The use of sufentanil was identified as a protective factor(OR=0.394, 95%CI: 0.187-0.789, P=0.011). CONCLUSIONS: Preoperative assessment of obese patients scheduled for maxillofacial surgery should emphasize evaluating neck mobility and maxillary protrusion. When necessary, difficult airway management protocols or awake intubation should be considered. Appropriate selection of anesthetic agents and induction strategies may help reduce the incidence of multiple intubation attempts.

Key words: Obesity, Oral and maxillofacial surgery, Tracheal intubation, Risk factors, Difficult airway

CLC Number:

R782.05

Nijiati Mierkamili, Zhou Ren, Sun Yu. Multiple intubation attempts in obese patients during oral and maxillofacial surgery: analysis of risk factors[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(2): 144-149.

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