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Betel-Nut Chewing Increases Difficulty in Tracheal Intubation.

Sheng-Yu Chen1, Yi-Seng Tsai2, Yu-Hua Wu1

  • 1Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Asian Journal of Anesthesiology
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Summary

Betel-nut chewing (BC) independently increases the risk of difficult tracheal intubation (DI), even with normal preoperative airway evaluations. Physicians should anticipate DI in BC patients.

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Area of Science:

  • Anesthesiology
  • Oral Medicine
  • Public Health

Background:

  • Betel-nut chewing (BC) is linked to oral submucous fibrosis (OSF), a condition potentially causing difficult tracheal intubation (DI).
  • Unanticipated DI has been observed in BC patients despite normal preoperative airway evaluations (PAEs).
  • This study investigates BC as an independent risk factor for DI beyond established predictors.

Purpose of the Study:

  • To determine if betel-nut chewing (BC) is an independent risk factor for difficult tracheal intubation (DI).
  • To assess the association between BC and intubation difficulty, considering preoperative airway evaluations (PAEs).

Main Methods:

  • A cohort of 2,682 patients was analyzed, focusing on 805 male patients undergoing classical intubation.
  • Prospective data collection included preoperative airway evaluations (PAEs), intubation difficulty scale (IDS), intubation time, and perceived DI.
  • Stepwise logistic regression using WEKA was employed to identify BC's effect on IDS, adjusting for related factors.

Main Results:

  • Betel-nut chewing (BC) patients showed a higher odds ratio for moderate-to-major intubation difficulty (adjusted OR, 1.75) and increased risk for specific Cormack-Lehane grades (II and IV).
  • BC was identified as an independent risk factor for difficult intubation (DI) (adjusted ORs 1.53 and 3.25 for specific grades).
  • Older age (≥46) and the presence of teeth were also significant risk factors for increased intubation difficulty.

Conclusions:

  • Betel-nut chewing (BC) independently increases tracheal intubation difficulty, even in patients without apparent oral submucous fibrosis (OSF) or with normal preoperative airway evaluations (PAEs).
  • BC is a significant risk factor for difficult intubation (DI) that should be considered alongside common DI prediction factors.
  • Healthcare providers should be prepared for potential difficult intubations in patients who practice betel-nut chewing.