Comparison of Predictable and Unpredictable Difficult Airway Cases in Gynecologic-Oncology Surgery Patients

Year 2023, , 557 - 563, 30.09.2023

Asude Ayhan , Ali Bakhshandehpour , Ibrahim Khan , Marwah Zayed , Teyyuba Muhammadli , Yasaman Bayatmakoo , Meriç Çolak , Elvin Kesimci

https://doi.org/10.18663/tjcl.1344158

Abstract

Aim: One of the factors contributing to anesthesia-related morbidity and mortality is difficult intubation. Although it is well established that airway examination plays a crucial role in predicting the presence of a difficult airway (DA) during preoperative assessment, the predictive tests currently being utilized have a high specificity but a poor sensitivity. In this study, we sought to identify and compare the predictable and unpredictable DA cases with preoperative airway examination in a patient population with high comorbidity who underwent surgical intervention under general anesthesia. We also determine the possible risk factors for difficult intubation.
Material and Methods: Between January and April 2022, a total of 162 patients who underwent general anesthesia for gynecological-oncology surgery and were at least 18 years old were evaluated prospectively. Following preoperative airway assessments, predictable and unpredictable DA were identified using the Simplified Airway Risk Index (SARI). In order to determine the factors that contributed to DA, patients were divided into groups with and without difficult intubation after endotracheal intubation using the "Intubation Difficulty Scale" (IRS).
Results: In the study, 32 patients (19.75%) were found to have predicted DA, and 130 individuals (80.25%) were found to have unpredicted DA. According to the IRS, DA was detected in 59 (36.4%) patients after intubation. A high palate (p = 0.016), long anterior incisors (LAI) (p = 0.046), Mallampati Score (MS) (p = 0.002), Thyromental distance (TD) (p = 0.003), and neck length measurement (NLM) were shown to be the factors determining the existence of DA. Furthermore, advanced age (>60 years, p=0.006) and the presence of chronic diseases (p=0.032) increased the probability of encountering DA.
Conclusion: The findings of the study demonstrated that preoperative MS, NLM, TD, LAI are found to be the most significant factors affecting the occurrence of DA. Attentive preoperative airway evaluation is critical while planning the DA and its management.

Keywords

general anesthesia, intubation, predictive tests, difficult airway

Project Number

KA21/541

Jinekolojik onkoloji hastalarında öngörülen ve öngörülemeyen zor havayolu olgularının karşılaştırılması

Abstract

Amaç: Anesteziye bağlı morbidite ve mortalite nedenlerinden bir tanesi zor ve/veya başarısız entübasyondur. Havayolu muayenesinin zor havayolu (ZH) varlığını öngörmedeki rolü bilinmekle birlikte, ameliyat öncesi dönemde bu amaçla kullanılan testlerin özgüllüğü yüksek, ancak özgünlüğü düşüktür. Bu çalışmada, genel anestezi altında cerrahi tedavi uygulanacak komorbiditesi yüksek bir hasta popülasyonunda, preoperatif havayolu değerlendirmesi ile öngörülen ve öngörülemeyen zor havayolu olgularını belirlemek, karşılaştırmak ve zor entübasyon için olası risk faktörlerini ortaya koymak amaçlanmıştır.
Gereç ve Yöntemler: Jinekolojik onkoloji cerrahisi için genel anestezi uygulanan, 18 yaş ve üzeri, toplam 162 hasta prospektif olarak çalışmaya dahil edildi. Preoperatif havayolu incelemeleri sonrasında; Basitleştirilmiş Havayolu Risk İndeksi (Simplified Airway Risk Index: SARI)’ne göre, ZH öngörülen ve öngörülemeyen olgular belirlendi. Endotrakeal entübasyon sonrasında Entübasyon Zorluk Skalası (Intubation Difficulty Scale: IRS)’na göre entübasyonu zor olan ve olmayan olgular gruplandırıldı, ZH’na neden olan etmenler ortaya konuldu
Bulgular: SARI’ya göre toplam 162 hastanın 32’si (%19,75) ZH öngörülen, 130’u (%80,25) ise ZH öngörülemeyen olarak değerlendirildi. Entübasyon sonrasında IRS’ye göre 59 (%36,4) olguda zor entübasyon varlığı kayıt edildi. Boyun uzunluk ölçümü (p<0.003), vücut kitle indeksi (p=0.01), uzun üst ön kesici dişler (p=0.046), Mallampati Skoru (p=0.002), tiromental mesafe (p=0.003), yüksek damak varlığı (p=0.016) ZH varlığını etkileyen faktörler olarak bulundu. Ayrıca bu hasta grubunda, ileri yaş (>60 yaş; p=0.006) ve kronik hastalık varlığında (p=0.032) ZH ile karşılaşılma ihtimalinin arttığı da izlendi.
Sonuç: Bu çalışma ile preoperatif hasta değerlendirmesinde kullanılan Mallampati skoru, boyun uzunluk ölçümü, tiromental mesafe ve ön kesici dişlerin uzun olmasının ZH varlığını etkileyen en önemli etmenler olduğu gösterilmiştir. Ameliyat öncesi dönemde yapılacak özenli havayolu muayenesinin ZH yönetimi için planlama yapılmasına olanak sağladığı düşünülmektedir.

Keywords

Genel anestezi, entübasyon, prediktif testler, zor havayolu

Supporting Institution

Başkent Üniversitesi Araştırma Fonu

Project Number

KA21/541

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