Mismatch Between Preoperative Airway Assessment and Unanticipated Difficult Tracheal Intubation: A Retrospective...

Area of Science:

• Anesthesiology
• Patient Safety
• Airway Management

Background:

• Unanticipated difficult airway is a critical patient safety concern in perioperative care.
• Difficult intubation can occur in patients without obvious high-risk findings despite routine preoperative assessment.

Purpose of the Study:

• To evaluate perioperative factors associated with unanticipated difficult intubation.
• To examine the relationship between preoperative assessment and intraoperative intubation difficulty.

Main Methods:

• Retrospective case-control study of adult patients undergoing general anesthesia with tracheal intubation (2015-2020).
• Unanticipated difficult intubation defined as ≥3 attempts without documented preoperative suspicion.
• Multivariable logistic regression used to explore associations (95 cases, 429 controls).

Main Results:

• Patients with unanticipated difficult intubation more frequently had ASA physical status III and airway deformity.
• Intubation difficulty often became evident only at laryngoscopy, with poorer visualization and increased attempts.
• Severe laryngoscopic views (Cormack-Lehane grade III-IV) were significantly more common in cases (74.8% vs. 3.0%).
• ASA III and airway deformity were independently associated with unanticipated difficult intubation.

Conclusions:

• Unanticipated difficult intubation is uncommon but clinically significant, often identified during airway management.
• Routine bedside airway assessment may not reliably predict all instances of intraoperative difficult intubation.
• Improved strategies are needed to identify patients at risk for difficult intubation.