Peer-reviewedCC BY-NC-SASaudi journal of anaesthesia1 Oct 2026

Predictors of failed intubation in patients with obesity-A systematic review.

Jumana M Zakaria Baaj¹
Abdullah Abdulrahman Alomran²
Yazan Alhussain Abuhoza²
Saud Mohammed Almousa²
Walid Mohamed Ragab Badwi¹
Samar Alqahtani³

¹Department of Anesthesiology, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia.
²Department of Anesthesia, College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia.
³Department of Anesthesia, College of Medicine, Imam Mohammed Bin Saud University, Riyadh, Saudi Arabia.

Abstract

Background

Difficult airway management is a serious issue in anesthetic practice, especially for patients with obesity, whose anatomical and physiological alterations make intubation difficult. Multiple predictors have been investigated, yet no clear consensus exists. This systematic review aimed to comprehensively identify reliable predictors of failed, or difficult intubation in adult patients with obesity.Methods

PRISMA 2020 guidelines were used in this study. Systematic searches were performed using the search engines of the databases PubMed, PubMed Central, Google Scholar, CrossRef, and CORE from 2015 to 2025. This study considered studies evaluating clinical or anatomical, or ultrasound-based predictors for difficult or failed intubation in adult patients with obesity.Results

Thirty-five trials were suitable for inclusion. The most important predictive factors were found to be neck circumference (NC) and particularly the neck-circumference-to-thyromental-distance ratio (NC/TMD) of ≥5.0. Ultrasound-derived parameters demonstrated superior diagnostic accuracy compared to traditional bedside assessments. Regarding quality of the included studies, 26 (74.3%) studies had low risk of bias, and eight studies (22.9%) had moderate risk, suggesting a high level of quality.Conclusion

The NC/TMD ratio, neck circumference, and thyromental distance are the most reliable predictors of difficult or failed tracheal intubation in patients with obesity. Body mass index alone lacks predictive accuracy, while incorporating ultrasound measurements enhances diagnostic precision.

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Cite

BibTeX RIS

BibTeX

@article{baaj2026predictors,
  title = {{Predictors of failed intubation in patients with obesity-A systematic review.}},
  author = {Jumana M Zakaria Baaj and Abdullah Abdulrahman Alomran and Yazan Alhussain Abuhoza and Saud Mohammed Almousa and Walid Mohamed Ragab Badwi and Samar Alqahtani},
  journal = {Saudi journal of anaesthesia},
  year = {2026},
  month = oct,
  doi = {10.4103/sja.sja_11_26},
  url = {https://europepmc.org/article/MED/42960334},
  note = {CC BY-NC-SA},
}

RIS

TY  - JOUR
TI  - Predictors of failed intubation in patients with obesity-A systematic review.
AU  - Jumana M Zakaria Baaj
AU  - Abdullah Abdulrahman Alomran
AU  - Yazan Alhussain Abuhoza
AU  - Saud Mohammed Almousa
AU  - Walid Mohamed Ragab Badwi
AU  - Samar Alqahtani
PY  - 2026
DA  - 2026/10/01
JO  - Saudi journal of anaesthesia
DO  - 10.4103/sja.sja_11_26
UR  - https://europepmc.org/article/MED/42960334
AB  - Background  Difficult airway management is a serious issue in anesthetic practice, especially for patients with obesity, whose anatomical and physiological alterations make intubation difficult. Multiple predictors have been investigated, yet no clear consensus exists. This systematic review aimed to comprehensively identify reliable predictors of failed, or difficult intubation in adult patients with obesity.Methods  PRISMA 2020 guidelines were used in this study. Systematic searches were performed using the search engines of the databases PubMed, PubMed Central, Google Scholar, CrossRef, and CORE from 2015 to 2025. This study considered studies evaluating clinical or anatomical, or ultrasound-based predictors for difficult or failed intubation in adult patients with obesity.Results  Thirty-five trials were suitable for inclusion. The most important predictive factors were found to be neck circumference (NC) and particularly the neck-circumference-to-thyromental-distance ratio (NC/TMD) of ≥5.0. Ultrasound-derived parameters demonstrated superior diagnostic accuracy compared to traditional bedside assessments. Regarding quality of the included studies, 26 (74.3%) studies had low risk of bias, and eight studies (22.9%) had moderate risk, suggesting a high level of quality.Conclusion  The NC/TMD ratio, neck circumference, and thyromental distance are the most reliable predictors of difficult or failed tracheal intubation in patients with obesity. Body mass index alone lacks predictive accuracy, while incorporating ultrasound measurements enhances diagnostic precision.
SN  - 1658-354X
SN  - 0975-3125
ER  -

Abstract

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