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

Tamirat Alemayehu; Mulualem Sitot; Abebayehu Zemedkun; Siryet Tesfaye; Dugo Angasa; Fasil Abebe

doi:10.1016/j.amsu.2022.103682

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

Ann Med Surg (Lond). 2022 Apr 28:77:103682. doi: 10.1016/j.amsu.2022.103682. eCollection 2022 May.

Authors

Tamirat Alemayehu¹, Mulualem Sitot², Abebayehu Zemedkun³, Siryet Tesfaye², Dugo Angasa⁴, Fasil Abebe⁵

Affiliations

¹ Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
² Addis Ababa University, College of Health Sciences, Department of Anesthesia, Addis Ababa, Ethiopia.
³ Dilla University, College of Health Sciences and Medicine, Department of Anesthesiology, Dilla, Ethiopia.
⁴ Hawassa University, Colleges of Medicine and Health Sciences, Hawassa, Ethiopia.
⁵ Ambo University, Colleges of Medicine and Health Sciences, Ambo, Ethiopia.

Abstract

Background: General anesthesia is not without morbidity. One of the well-known life-threatening events associated with general anesthesia is difficult airway which can happen during induction of anesthesia while attempting to insert the endotracheal tube with the aid of a laryngoscope. Difficult intubation, inadequate ventilation, and esophageal intubation are the principal causes of death or brain damage related to airway manipulation.

Objective: The main objective of this study was to assess the magnitude and predictors for difficult laryngoscopy and intubation among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation at Tikur Anbessa Specialized Hospital from February 1 to March 30, 2019.

Materials &method: An institutional based cross sectional study was conducted from February 1 to March 30, 2019 on patients who underwent elective surgery under general anesthesia with endotracheal intubation. Data on socio-demographic characteristics, preanesthetic airway assessment and laryngoscopic view were collected. Data were analyzed by SPSS Version 20.0. Chi- square test, binary logistic regression and multivariate analysis were performed. Tables and texts were used to present data. A p value less than 0.05 was considered as statistically significant.

Results: The magnitude of difficult laryngoscopy, difficult intubation, and failed intubation were 12.2%, 6.1%, and 0.67%, respectively. Upper Lip Bite Test (ULBT) had a higher sensitivity (90.2%) and negative predictive value of 85.3%. Mallampati had a sensitivity of 45.8% and negative predictive value of 86% in predicting difficult laryngoscopy. Mallampati grade, thyromental distance and ratio of height to thyromental distance (HRTMD) have also showed greater sensitivity (69.6%, 58.3% and 47.8%, respectively) when compared to other tests in predicting difficult intubation. Mallampati class, upper lip bite test (ULBT) and inter-incisor distance (IID) are independent predictors for difficult laryngoscopy (p < 0.05). Furthermore, Mallampati class, Thyromental distance and ratio of height to thyromental distance (HRTMD) are identified as independent predictors of difficult intubation (p < 0.001).

Conclusion: and recommendation: Mallampati class, Thyromental distance and Ratio of height to Thyromental distance (HRTMD) can predict the probability of difficult endotracheal intubation in adult patients. Whereas, Mallampati class and upper lip bite test (ULBT) predicts higher probability for difficult laryngoscopy.

Keywords: Difficult airway; Difficult intubation; Difficult laryngoscopy; Intubation; Predictors.