• Patrick Hartsuyker, Marcelo E Kanczuk, David Lawn, Salwa Beg, Tesfaye S Mengistu, and Matthew Hiskens.
• James Cook University, North Mackay, QLD, Australia. patrick.hartsuyker@health.qld.gov.au.
• Can J Anaesth. 2023 Nov 1; 70 (11): 174417521744-1752.

PurposeSupraglottic airway devices (SGAs) have been increasingly used as a primary airway in patients undergoing anesthesia as an alternative to endotracheal tubes. Second-generation devices have expanded their applicability to include uses in patients with obesity. Nevertheless, there is limited evidence of SGA suitability for patients with class 3 obesity (body mass index [BMI] ≥ 40 kg·m-2). As such, we compared rates of SGA functionality between patients with class 3 obesity and patients without class 3 obesity undergoing general anesthesia.MethodsWe performed a propensity score matching analysis using inverse probability of treatment weighting to compare the functionality of SGAs in adult patients with class 3 obesity vs without class 3 obesity. These patients underwent surgery at a hospital in Queensland, Australia from November 2017 to September 2020 and had a SGA inserted as part of their anesthetic care. All data were collected from patients' electronic medical records. We included 321 patients in the cohort with class 3 obesity and 471 in the cohort without class 3 obesity (control/comparison). The estimated effect of class 3 obesity on SGAs was calculated using adjusted odds ratios (AORs) with their 95% confidence intervals (CIs).ResultsThe overall weighted prevalence of nonfunctional SGAs was 3.2%, with a significantly higher rate in the class 3 obesity cohort compared with the control cohort (4.7% vs 2.1%) (P = 0.04). This adjusted analysis illustrates that class 3 obesity was associated with an almost four times higher odds of a nonfunctional SGA (odds ratio [OR], 2.3; 95% CI, 1.0 to 5.1; AOR, 3.9; 95% CI, 1.4 to 10.6) than patients without class 3 obesity.ConclusionPatients with class 3 obesity (BMI ≥ 40 kg·m-2) had greater than three-fold odds of nonfunctional intraoperative SGAs than patients without class 3 obesity.© 2023. Crown.

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