Difficult tracheal intubation--analysis and management in 37 cases

Area of Science:

• Anesthesiology
• Airway Management
• Surgical Anatomy

Background:

• Difficult endotracheal intubation poses a significant challenge in general anesthesia.
• Identifying predictive anatomical markers is crucial for patient safety.

Purpose of the Study:

• To analyze anatomical features of difficult airways during general anesthesia.
• To investigate strategies for managing difficult intubation in a local population.

Main Methods:

• Prospective analysis of difficult intubation cases over 1.5 years.
• Definition of difficult intubation: failure to visualize the larynx after specific maneuvers.

Main Results:

• 37 difficult intubations identified in 5,379 general anesthesia cases.
• Common anatomical features: receding chin, limited mouth opening/neck extension, abnormal dentition, short thyromental distance, large tongue, supraglottic mass, floppy epiglottis.
• Gum elastic bougie, laryngeal mask, and fiberoptic bronchoscopy were common interventions.

Conclusions:

• Assessing multiple anatomical features can improve difficult intubation prediction.
• Key predictors include chin recession, neck extension, mouth opening, dentition, tongue size, and thyromental distance, potentially identifying 81% of cases.
• Epiglottis and glottic inlet anomalies present unpredictable challenges.