Incidence and predictors of difficult airway in elective surgical patients: A hospital-based observational study.

Dr Sudheer Kumar  Kotagiri; Dr Ashok  Gunda

doi:10.51168/sjhrafrica.v6i12.2248

Authors

Dr . Sudheer Kumar Kotagiri Assistant Professor, Department of Anaesthesiology, Government Medical College and General Hospital, Jagtial, Telangana, India
Dr. Ashok Gunda Assistant Professor, Department of Anaesthesiology, Government Medical College and General Hospital, Karimnagar, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2248

Keywords:

Difficult airway, elective surgery, Mallampati grading, thyromental distance, airway predictors, anesthesia safety

Abstract

Background:

Difficult airway remains a major challenge in anesthetic practice and is associated with increased perioperative morbidity when not anticipated. Despite routine preoperative evaluation, unexpected airway difficulty continues to occur in elective surgical patients, highlighting the need to identify reliable predictive parameters.

Objectives:

To determine the proportion of difficult airways among elective surgical patients and to assess the predictive value of commonly used preoperative airway assessment parameters.

Materials and Methods:

This hospital-based observational study included 80 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation. Preoperative airway assessment included Mallampati classification, thyromental distance, inter-incisor distance, cervical spine mobility, and neck circumference. Laryngoscopy was performed using a Macintosh blade. Difficult laryngoscopy was defined as Cormack–Lehane grade III or IV, while difficult intubation was defined by more than two attempts, prolonged intubation time, or need for advanced adjuncts. Data were analyzed using descriptive statistics and multivariate logistic regression.

Results:

The proportion of patients with a difficult airway was 13.8%. Difficult laryngoscopy occurred in 12.5% and difficult intubation in 8.8% of cases. Higher Mallampati grades (III–IV), reduced thyromental distance (<6.5 cm), restricted mouth opening, limited cervical mobility, and increased neck circumference (>40 cm) were significantly associated with a difficult airway. Multivariate analysis identified reduced thyromental distance (Adjusted OR 4.2) and Mallampati Class III–IV (Adjusted OR 3.6) as the strongest independent predictors. Mild desaturation occurred exclusively in the difficult airway group.

Conclusion:

Focused preoperative assessment using Mallampati grading and thyromental distance, supported by complementary airway parameters, can facilitate early identification of high-risk patients and improve perioperative airway safety.

Recommendations:

Standardized airway assessment and readiness with basic airway adjuncts should be ensured for high-risk patients.

Author Biographies

Dr . Sudheer Kumar Kotagiri , Assistant Professor, Department of Anaesthesiology, Government Medical College and General Hospital, Jagtial, Telangana, India

is an Assistant Professor in the Department of Anaesthesia at Government Medical College, Jagtial, Telangana. He completed his MBBS from Narayana Medical College and Hospital, Nellore, followed by an MD in Anaesthesia from Government Siddhartha Medical College, Vijayawada. He has been serving in the Telangana State Health Department since 2009 and has extensive experience in providing perioperative and critical care services. His academic interests include airway management, regional anesthesia, and enhancing patient safety through evidence-based anaesthetic practices. He is actively involved in teaching undergraduate and postgraduate trainees and contributes to institutional clinical research activities.ORCID iD: https://orcid.org/0009-0003-6492-3162

Dr. Ashok Gunda, Assistant Professor, Department of Anaesthesiology, Government Medical College and General Hospital, Karimnagar, Telangana, India

is an Assistant Professor in the Department of Anaesthesia at Government Medical College, Karimnagar, Telangana. He obtained his MBBS from Osmania Medical College, Hyderabad, and completed his MD in Anaesthesia from Chalmeda Anand Rao Institute of Medical Sciences (CAIMS), Karimnagar. He has been serving in the Telangana State Health Department since 22 May 2023. His clinical interests include perioperative anesthesia, airway management, and patient safety optimization. Dr. Ashok is actively engaged in teaching, clinical service, and departmental academic activities, contributing to improved anaesthesia care within the institution.

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