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

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.