Multicenter Variation in
Supraglottic Airway Device Use
and Pulmonary Complications
Focus on the Obese Population
Roberta T. Tallarico, MD
Researcher Associate, Anesthesia University of California San Francisco
MPOG Research Fellow 2023
Anesthesia Resident (PGY 1) Washington University in Saint Louis
Research Support
FAST-CaR Seed Grant
NIH T32 Postdoc Research Fellowship
RAP Grant for Ongoing NIH T32 Project
Main Results
Study Design
Study Relevance
Lessons Learned
SGA: Supraglottic Airway
ETT: Endotracheal Tube
Study Relevance
Guidelines
Obese
Population
Clinical
Practice
Study Design
Multicenter Retrospective Observational and
Cross-sectional Analysis
From 01/01/2019 to 12/31/2022
AIM 1: Describe the Practice Patterns across MPOG Institutions
of SGA among Obese patients undergoing General Anesthesia
AIM 2: Evaluate adjusted associations between
clinician- and institution-level SGA practice patterns and
pulmonary complication and 30-day mortality of obese patients
Adult Patients
BMI ≥ 30 kg/m
2
Procedures under
General Anesthesia
for which SGA would be
considered an option
46%
54%
189,303 Patients
55 Institutions
66% > 500 beds
72%
Medical School
Affiliation
TOP 10 Procedures
0 2000 4000 6000 8000 10000 12000 14000 16000 18000
Knee arthroscopy
Ureteral stone removal
Orthopedic surgery - shoulder
Orthopedic surgery leg and foot
Hysteroscopy
Perineal procedures
Total knee arthroplasty
Vaginal surgery
Transurethral procedures
Orthopedic surgery forearm & hand
SGA (N)
ETT (N)
BMI Category
Percentage(%)
ETT and SGA
Procedures by BMI
Pulmonary Complication
Odds Ratio (95% CI)
30-day Mortality
Odds Ratio (95% CI)
Lessons Learned
from MPOG Research Fellow & Project
Networking
"Behind the scene"
discussions
Phenotypes & Data Direct
Research
Consultation
Meetings
Thank
You
Obrigada
References
1. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM,Ahmad I: Difficult Airway Society 2015 guidelines for
management of unanticipated difficult intubation in adults. British Journal of Anaesthesia 2015; 115:82748
2. Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, Martin LD, Linton J, Epps JL, Fernandez-Bustamante A, Jameson LC, Tremper T, Tremper
KK: Incidence, Predictors, and Outcome of Difficult Mask Ventilation Combined with Difficult Laryngoscopy. Anesthesiology 2013; 119:13609
3. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O’Sullivan EP, Rosenblatt
WH, Sorbello M, Tung A: 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;
136:3181
4. Shaw M, Waiting J, Barraclough L, Ting K, Jeans J, Black B, the Pan-London Peri-operative Audit and Research Network: Airway events in obese vs. non-obese
elective surgical patients: a cross-sectional observational study. Anaesthesia 2021; 76:158592
5. Turna CK, Arslan ZI, Alparslan V, Okyay K, Solak M: Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation
in obese patients: a randomised clinical trial. Brazilian Journal of Anesthesiology (English Edition) 2020; 70:11824
6. Cullen A, Ferguson A: Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anesth/J Can Anesth 2012;
59:97496
7. Pourciau DC, Hotard DP, Hayley S, Hayley K, Sutton C, McWhorter AJ, Fink DS: Safety and efficacy of laryngeal mask airway ventilation in obese patients with
airway stenosis: LMA Ventilation in Obese Patients. The Laryngoscope 2017; 127:2582–4
8. Moser B, Keller C, Audigé L, Dave MH, Bruppacher HR: Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective,
randomized trial of the Ambu
®
AuraGain
TM
laryngeal mask vs the i-gel
TM
airway. Acta Anaesthesiol Scand 2019; 63:18794
9. Wang H-X, Wan L, Tian M, Xue F-S: A safe strategy for anesthesia induction and airway management in morbidly obese patients. Chinese Medical Journal
2019; 132:17478
10. Ramachandran SK, Tremper KK: Predictors and Clinical Outcomes from Failed Laryngeal Mask Airway Unique
TM
. PERIOPERATIVE MEDICINE
11. Simon LV, Torp KD: Laryngeal Mask Airway, StatPearls. Treasure Island (FL), StatPearls Publishing, 2023 at
<http://www.ncbi.nlm.nih.gov/books/NBK482184/>
12. Merlo J: A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate
contextual phenomena. Journal of Epidemiology & Community Health 2006; 60:290–7
13. Lee E, Hong S. Adequate Sample Sizes for a Three-Level Growth Model. Front Psychol. 2021 Jul 1;12:685496. doi: 10.3389/fpsyg.2021.685496.
PMID: 34276510; PMCID: PMC8282204.
14. Bartlett JW, Seaman SR, White IR, Carpenter JR, Alzheimer’s Disease Neuroimaging Initiative*: Multiple imputation of covariates by fully conditional
specification: Accommodating the substantive model. Stat Methods Med Res 2015; 24:46287