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Predictors of difficult airway in patients with obstructive sleep apnea-hypopnea syndrome during general anesthe- sia
Author(s): LI Ling, WANG Chunling, ZHANG Li, LI Yanzhong
Pages: 62-
67
Year: 2017
Issue:
6
Journal: Journal of Otolaryngology and Ophthalmology of Shandong University
Keyword: Anesthesia; Obstructive sleep apnea hypopnea syndrome; Difficult mask ventilation; Difficult intubation; Acute respiratory obstruction;
Abstract: Objective This study aimed to find predictors for difficult mask ventilation and intubation in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) , and to decrease the incidence of difficult airway during general anesthesia. Methods Based on the inclusion criteria, 128 OSAHS patients diagnosed by polysomnography were includ-ed in the study. After general anesthesia induction, the incidence of difficult mask ventilation and difficult intubation were recorded;patient characteristics were also documented. Univariate analyses were performed to identify the potential risk factors for difficult mask ventilation and difficult intubation. Factors identified as having a significant association with difficult mask ventilation and difficult intubation were then subjected to stepwise multiple logistic regression analy-sis, to evaluate confounding among these predictors. Results Difficult mask ventilation was present in 64. 8% ( 83/128) of the OSAHS patients;the rate of difficult intubation was 51.6% (66/128). The univariate analyses showed that difficult mask ventilation was associated with body mass index ( BMI) , apnea-hypopnea index ( AHI) , neck circumfer-ence ( NC) , waist circumference ( WC) , neck circumference to height ratio ( NC/H) , waist circumference to height ratio ( WC/H) , Mallampati score, and Cormack and Lehane classification. Multiple logistic regression analysis showed that BMI, NC, Mallampati score, and Cormack and Lehane classification were independent predictors of difficult mask ventilation. Difficult intubation was associated with BMI, the lowest oxygen saturation ( LSaO2 ) level, AHI, WC, WC/H, interincisor distance ( ICD) , Mallampati score, and Cormack and Lehane classification. Multiple logistic re-gression analysis showed that AHI and Cormack and Lehane classification were independent predictors of difficult intu-bation;ICD was the protective factor for difficult intubation. Conclusion OSAHS patients presented with a high risk of difficult airway. BMI, NC, Mallampati score, and Cormack and Lehane classification were independent predictors of difficult mask ventilation. AHI, ICD, and Cormack and Lehane classification were strongly linked with difficult intubation.
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