Perioperative airway events in pediatric patients with obesity undergoing bariatric surgery: A retrospective cohort.

Objective: Obesity presents challenges in airway management due to physiological and anatomical changes, increasing the risk of difficult mask ventilation and tracheal intubation. This study aimed to determine the frequency and types of airway complications and identify risk factors for difficult intubation and extubation in pediatric patients undergoing bariatric surgery. Material and Methods: This retrospective cohort included 269 patients aged 12-17 years with body mass index ≥30 undergoing bariatric surgery under general anesthesia in Hamad Medical Corporation operating rooms between January 1, 2014, and January 1, 2024. We collected demographic data, preoperative airway assessment values; postoperative airway complications, and vital parameters. Multivariable logistic regressions were performed to assess variables associated with difficult intubation or extubation. Results: Of the 269 patients, one developed cardiovascular instability post-operatively and one experienced bronchospasm after intubation. None of the patients experienced laryngospasm, vomiting, or airway edema. Desaturation occurred in 10 (3.6%) patients during intubation and 14 (5.1%) during extubation. Male sex was associated with a higher odd of difficult intubation [odds ratio (OR) 2.28, 95% confidence interval (CI): 0.95-5.49, p=0.065] and extubation (OR 3.83, 95% CI: 0.85-17.35, p=0.082). More than one intubation attempt increased the odds of difficult extubation 15.52- fold (95% CI: 1.83-131.37, p=0.012). Conclusion: Male pediatric patients with obesity, especially with a history of snoring, are at higher risk for difficult intubation. Multiple intubations attempts strongly predict difficult extubation.