Preoperative Predictors of Difficult Intubation

Abstract

BACKGROUND:Because a difficult intubation may occur unexpectedly, airway examination is the most criticalcomponent of anesthetic practice. Prior to surgery, all of the patients' airway parameters were examined.Parameters included age, body mass index, neck circumference, head movement, mouth opening space,mandibular length, sternomental and thyromental distance, dental deformities, as well as a history ofmedical, surgical, and difficult intubation were all taken into consideration with thyroid related factors(tracheal deviation and retrosternal goiter).In respect to the preoperative parameters, all patients werecategorized intraoperative, using the Cormack and Lehane laryngoscopic View. Clinical data from eachtest was collected, and analyzed to establish its relevance, positive predictive value, and negativepredictive value.AIM OF THIS STUDY:The effectiveness of airway characteristics in predicting difficult intubation was compared ina prospective research to enhance airway management especially in those with difficult intubation toprevent post operative morbidity and mortality airways complication.METHODS:From January 1 to June 30, 2021, a cross-sectional study was conducted on 72 patients their age rangebetween 25-70 years old both genders .They were admitted to the Baghdad Medical City TeachingHospital for a variety of elective procedures. The patients were collected and examined preoperativelyinvolving the age, gender, weight and length with special evaluation of upper airway assessmentincluding neck movement is assessed by extending the head at the atlanto-occipital joint and performingthe cervical flexion-rotation test manually.RESULT:The findings revealed a 13.9 percent incidence of problematic intubation among the 72 patients studied.Higher prevalence of difficult intubation noticed significantly among patients with past medical history(44.4%) , patients with abnormal dentation (36.4%) also Prevalence of difficult intubation wasincreasing with aging to reach (30% )in patients aged ≥ 50 years. Difficult neck movement beforesurgery was significantly associated with difficult intubation (P= 0.001). In this study, means of mouthopening and sternomental distance were significantly (P < 0.05) lower in patients with difficult intubationthan those with easy intubation. No statistically significant correlation (P ≥ 0.05) % between Cormack-Lehane grading system and any of the other characteristic.CONCLUSION:In this study we discovered that patients with a positive past medical history like history of diabetesmellitus and those with abnormal dentation are highly significant preoperative Intubation difficultypredictors. The risk of difficult intubation also increases in patients over the age of 50, difficult neckmovement, and in patients with limited mouth opening, as well as short sternomental distance.