Editorial highlights findings from a systematic review comparing videolaryngoscopy and direct laryngoscopy in obesity, suggesting new approaches for anaesthesia management.
AnaesthesiaEarly View Editorial Tipping the scales: obesity, anaesthesia and the new normal This article relates to: Videolaryngoscopy vs. direct laryngoscopy in class 2 and 3 obesity: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials* Zhi Jie Goh, Aaron Ang, Si-Xian Nicole Ang, Shermaine See, Jinbin Zhang, Kumaresh Venkatesan, Wan-Ling Alyssa Chiew, Volume 80Issue 6Anaesthesia pages: 684-693 First Published online: April 8, 2025 Andrew McKechnie, Corresponding Author Andrew McKechnie [email protected] @admckdoc Department of Anaesthesia, Lewisham and Greenwich NHS Trust, London, UK Correspondence to: Andrew McKechnie Email: [email protected]Search for more papers by this authorZoë A. Burton, Zoë A. Burton @drzoeburton @SOBAuk Department of Anaesthesia, Sheffield Children's NHS Foundation Trust, Sheffield, UKSearch for more papers by this author Andrew McKechnie, Corresponding Author Andrew McKechnie [email protected] @admckdoc Department of Anaesthesia, Lewisham and Greenwich NHS Trust, London, UK Correspondence to: Andrew McKechnie Email: [email protected]Search for more papers by this authorZoë A. Burton, Zoë A. Burton @drzoeburton @SOBAuk Department of Anaesthesia, Sheffield Children's NHS Foundation Trust, Sheffield, UKSearch for more papers by this author First published: 16 September 2025 https://doi.org/10.1111/anae.16775 1 Department of Anaesthesia, Lewisham and Greenwich NHS Trust, London, UK 2 Department of Anaesthesia, Sheffield Children's NHS Foundation Trust, Sheffield, UK This editorial accompanies articles by Goh et al. https://doi.org/10.1111/anae.16578, Qin et al. https://doi.org/10.1111/anae.16573 and Tognolini et al. https://doi.org/10.1111/anae.16531, Anaesthesia 2025. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookxLinkedInRedditWechatBluesky References 1 World Health Organization. WHO European Regional Obesity Report 2022. 2022. https://www.who.int/europe/publications/i/item/9789289057738 (accessed 21/08/2025). Google Scholar 2 World Health Organization. Report on the fifth round of data collection, 2018–2020: WHO European Childhood Obesity Surveillance Initiative (COSI). 2022. https://www.who.int/europe/publications/i/item/WHO-EURO-2022-6594-46360-67071 (accessed 21/08/2025). Google Scholar 3 GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the global burden of disease study 2021. Lancet 2025; 405: 813–838. https://doi.org/10.1016/S0140-6736(25)00355-1. 10.1016/S0140-6736(25)00355-1 Google Scholar 4Wiedemann UC, Van Den Akker E, Barber TM, et al. Early-onset of obesity-model: impact of early-onset obesity on life expectancy and on risks of comorbidities. Obes Facts 2024; 17(Suppl 1): 277–278. https://doi.org/10.1159/000538577. 10.1159/000538577 Google Scholar 5 World Obesity Federation. World Obesity Atlas 2023. 2023. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023 (accessed 21/08/2025). Google Scholar 6English S, Vallis M. Moving beyond eat less, move more using willpower: reframing obesity as a chronic disease impact of the 2020 Canadian obesity guidelines reframed narrative on perceptions of self and the patient-provider relationship. Clin Obes 2023; 13: e12615. https://doi.org/10.1111/cob.12615. 10.1111/cob.12615 PubMed Web of Science® Google Scholar 7 National Institute for Health and Care Excellence. Overweight and obesity management: Identifying and assessing overweight, obesity and central adiposity. [NG246]. 2025. https://www.nice.org.uk/guidance/ng246/chapter/Identifying-and-assessing-overweight-obesity-and-central-adiposity (accessed 21/08/2025). Google Scholar 8 Lancet Diabetes Endocrinol. Redefining obesity: advancing care for better lives. Lancet Diabetes Endocrinol 2025; 13: 75. https://doi.org/10.1016/S2213-8587(25)00004-X. 10.1016/S2213-8587(25)00004-X PubMed Google Scholar 9Burton ZA, Lewis R, Bennett T, et al. Prevalence of perioperative childhood obesity in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study. Br J Anaesth 2021; 127: 953–961. https://doi.org/10.1016/j.bja.2021.07.034. 10.1016/j.bja.2021.07.034 PubMed Web of Science® Google Scholar 10 Royal College of Anaesthetists. At the Heart of the Matter: Report and findings of the 7th National Audit Project of the Royal College of Anaesthetists examining Perioperative Cardiac Arrest. 2023. https://www.rcoa.ac.uk/research/research-projects/national-audit-projects-naps/nap7-report (accessed 21/08/2025). Google Scholar 11Goh ZJ, Ang A, Ang SN, See S, Zhang J, Venkatesan K, Chiew WA. Videolaryngoscopy vs. direct laryngoscopy in class 2 and 3 obesity: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Anaesthesia 2025; 80: 684–693. https://doi.org/10.1111/anae.16578. 10.1111/anae.16578 PubMed Web of Science® Google Scholar 12Chaudery H, Hameed H, Sharif Z, Asinger S, McKechnie A. Comparative efficacy of videolaryngoscopy and direct laryngoscopy in patients living with obesity: a meta-analysis. Cureus 2024; 16: e76558. https://doi.org/10.7759/cureus.76558. 10.7759/cureus.76558 PubMed Google Scholar 13Hoshijima H, Denawa Y, Tominaga A, Nakamura C, Shiga T, Nagasaka H. Videolaryngoscope versus macintosh laryngoscope for tracheal intubation in adults with obesity: a systematic review and meta-analysis. J Clin Anesth 2018; 44: 69–75. https://doi.org/10.1016/j.jclinane.2017.11.008. 10.1016/j.jclinane.2017.11.008 PubMed Web of Science® Google Scholar 14Carron M, Ieppariello G, Linassi F. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in obese adults: a meta-analysis. J Clin Anesth 2021; 71: 110216. https://doi.org/10.1016/j.jclinane.2021.110216. 10.1016/j.jclinane.2021.110216 PubMed Web of Science® Google Scholar 15McKechnie A, Iliff HA, Black R, et al. Airway management in patients living with obesity: best practice recommendations from the Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2025; 80: 1103–1114. https://doi.org/10.1111/anae.16647. 10.1111/anae.16647 PubMed Web of Science® Google Scholar 16Qin PP, Wang ZQ, Liu L, et al. The association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgery: a retrospective cohort study. Anaesthesia 2025. Epub 18 February. https://doi.org/10.1111/anae.16573. 10.1111/anae.16573 PubMed Web of Science® Google Scholar 17Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003; 361: 2032–2035. https://doi.org/10.1016/S0140-6736(03)13640-9. 10.1016/S0140-6736(03)13640-9 PubMed Web of Science® Google Scholar 18Lee DH, Keum N, Hu FB, Orav EJ, Rimm EB, Willett WC, Giovannucci EL. Predicted lean body mass, fat mass, and all cause and cause specific mortality in men: prospective us cohort study. BMJ 2018; 362: k2575. https://doi.org/10.1136/bmj.k2575. 10.1136/bmj.k2575 PubMed Google Scholar 19Tognolini AR, Liu X, Pandey S, Roberts JA, Wallis SC, Jackson D, Eley VA. Dosing optimisation of intravenous lidocaine in patients with class 1–3 obesity by population pharmacokinetic analysis. Anaesthesia 2025; 80: 511–521. https://doi.org/10.1111/anae.16531. 10.1111/anae.16531 CAS PubMed Web of Science® Google Scholar 20 Centre for Perioperative Care. Preoperative assessment and optimisation for adult surgery. 2021. https://www.cpoc.org.uk/sites/cpoc/files/documents/2021-06/Preoperative%20assessment%20and%20optimisation%20guidance.pdf (accessed 15/07/2025). Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation
No takes yet. Share an insight, caveat, or question.
McKechnie et al. (2025) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: