Evaluation of induction practices for general anesthesia in patients with obesity: A French nationwide online survey

IF 6 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2026-03-01 Epub Date: 2026-02-11 DOI:10.1016/j.jclinane.2026.112147

Tanguy Barthélémy , Marc Garnier , Audrey De Jong , Thomas Godet , Emmanuel Futier , Pierre Borrel , Laurent Renard Triché , Mathilde Lapeyre , Benjamin Andanson , Matthieu Jabaudon

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引用次数: 0

Abstract

Background

Obesity is a growing public health issue associated with increased peri-induction risk during general anesthesia, particularly airway-related complications. Substantial variability in national and international guidelines may contribute to heterogeneous clinical practice. This study aimed to describe anesthetic induction practices in patients with obesity in France and to explore the influence of body mass index and obesity-related comorbidities on the decision for or against rapid sequence induction.

Methods

This nationwide declarative survey used an anonymous online questionnaire distributed to French anesthesiologists between May and December 2024. Using standardized theoretical clinical scenarios, induction strategies were classified as rapid sequence induction or conventional induction, as reported by participants. Data were analyzed descriptively, with group comparisons performed using Pearson's chi-square test.

Results

Of the 665 responses collected, 652 were analyzed, revealing wide variability in practices. For a body mass index of 43 kg/m², 57% of participants would not perform rapid sequence induction. Among respondents, 33% regarded a body mass index threshold of ≥40 kg/m² as appropriate for initiating rapid sequence induction, whereas 24% did not define any specific threshold. Rapid sequence induction was primarily selected for patients with daily gastroesophageal reflux disease, gastroesophageal reflux disease associated with a hiatal hernia, or a history of bariatric surgery. Anesthesiologist experience was associated with differences in the choice of induction sequence (p = 0.003). Considerable heterogeneity remained in the calculation of neuromuscular blocking agent doses: 28% of practitioners used total body weight for non-depolarizing agents. Apneic oxygenation remained underused, with 32% of respondents reporting that they never used it.

Conclusions

This nationwide survey highlights substantial variability in anesthetic induction practices for patients with obesity, reflecting the absence of consensus. These findings underscore the need for further evidence to inform future recommendations and optimize anesthetic management in this high-risk population.

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肥胖患者全身麻醉诱导实践的评估：法国全国在线调查

背景：肥胖是一个日益严重的公共卫生问题，与全身麻醉诱导围期风险增加有关，特别是与气道相关的并发症。国家和国际指南的巨大差异可能导致临床实践的异质性。本研究旨在描述法国肥胖患者的麻醉诱导实践，并探讨体重指数和肥胖相关合并症对决定是否进行快速序列诱导的影响。方法该调查采用匿名在线问卷，于2024年5月至12月向法国麻醉医师发放。使用标准化的理论临床场景，诱导策略被分为快速序列诱导和常规诱导。对数据进行描述性分析，采用Pearson卡方检验进行组间比较。结果在收集到的665份回复中，分析了652份，揭示了实践中的广泛差异。对于身体质量指数为43 kg/m2的参与者，57%的人不会进行快速序列诱导。在受访者中，33%的人认为体重指数阈值≥40 kg/m2是启动快速序列诱导的合适阈值，而24%的人没有定义任何特定阈值。快速序列诱导主要用于每日胃食管反流病、胃食管反流病合并裂孔疝或有减肥手术史的患者。麻醉医师经验与诱导顺序选择的差异相关（p = 0.003）。在计算神经肌肉阻断剂剂量时仍然存在相当大的异质性：28%的从业人员使用总体重来计算非去极化剂。呼吸暂停氧合仍未得到充分利用，32%的受访者报告他们从未使用过。结论：这项全国性的调查强调了肥胖患者麻醉诱导实践的实质性差异，反映了缺乏共识。这些发现强调需要进一步的证据来指导未来的建议和优化这一高危人群的麻醉管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.