Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

Abstract

Introduction. The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective. The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design. A facility-based cross-sectional study design was used. Result. In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation. We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.

Assessment of predictors for difficult intubation and laryngoscopy in adult elective surgical patients at Tikur Anbessa Specialized Hospital, Ethiopia: A cross-sectional study

“…Preoperative assessment of the patient's airway facilitates the anesthetists to predict the ease of visualizing the glottis and to perform intubation easily. Furthermore, Management of the difficult airway is one of the most relevant issues and core competency for practicing anesthetists [ [1] , [2] ]. Maintaining a patent airway is must for adequate oxygenation and ventilation and failure to do so, even for a brief period of time can be life threatening.…”

The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study

“…[10][11][12][13][14] Assessing the airway parameters like the oropharyngeal view, thyromental distance, hyomental distance, or other predictors of difficult airway in pediatrics patients is difficult in managing difficult airway case scenarios. 13,[15][16][17] Studies regarding difficult airways in pediatric patients were not established well in developing countries like Ethiopia. Therefore, this study aims to determine the prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia in referral hospitals of Addis Ababa.…”

General anesthesia for giant tumor resection and facial reconstruction in a patient with atrial fibrillation, hypertension, heart valve diseases (Case report).

“…The patient has been identified as having difficulty endotracheal intubation due to Mallampati IV [2]. She was unable to receive mask ventilation after general induction due to the large tumor on the right side of the face invading the nose and the palate.…”