Ali Abas, Kassahun Bilen, Habtu Elias, Debalkie Ashebir, Seid Kerima, Awol Redi, Suleman Mohammed, Girma Bizuwork, Eanga Shamill, Oumer Abdi, Mosa Hassen, Tafesse Dawit, Bati Temesgen, Dendir Getahun
Department ofAnesthesia, College of Medicine and Health Sciences, Werabe University, Werabe.
School of Anesthesia, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita.
Ann Med Surg (Lond). 2024 Jan 26;86(10):5724-5732. doi: 10.1097/MS9.0000000000001754. eCollection 2024 Oct.
"Difficult airway" is the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, laryngoscopy, and difficulty with tracheal intubation, or both. Associated factors and predictive value difficult airways, maxillofacial surgery study setup is under studied.
To determine the magnitude and associated factors of difficult airways and predictive value of airway examinations among adult patients who underwent maxillofacial surgery at public hospitals in Southern Ethiopia 2022.
An institutional-based multicenter cross-sectional study was conducted among 250 maxillofacial patients from March to 30 June 2022 at selected hospitals. The data were entered into Epi_Data software version 4.3 and analyzed by STATA software version 14. All variables that were statistically significant in bivariate analysis, at the less than 0.25, were included in the multivariate logistic regression analysis. The predictive value or the effectiveness of airway examinations in predicting difficult airways was analyzed by receiver operating curve.
In the current study, the magnitude of difficult airways was 21.2% (95% CI = 16.3-26.1%) and the magnitude of difficult intubation, difficult laryngoscopy, and difficult mask ventilation was 6.4% (95% CI 3.3-9.4%), 9.6% (95% CI 6.1-13%), and 13.6% (95% CI (9.1-16.8%), respectively. History of head and neck surgery adjusted odds ratio (AOR)=6.3, 95% CI (2.85-14.34), cervical collar AOR=4.9, 95% CI (1.96-12.49), and cervical spine injury AOR=2.4, 95% CI (1.07-5.38) were independently and significantly associated with difficulty of airway. Modified Mallampati class and sternomental distance were identified as good preoperative tests to predict difficult laryngoscopy, intubation, and mask ventilation.
The magnitude of difficult airways was maxillofacial surgery. Among various airway assessment tests, no single test was perfectly accurate. Anaesthesia professionals are recommended to use a combination of preoperative airway assessments.
“困难气道”是指经过常规培训的麻醉医生在面罩通气、喉镜检查及气管插管过程中遇到困难，或两者皆有困难的临床情况。困难气道的相关因素及预测价值、颌面外科手术研究设置尚未得到充分研究。
确定2022年在埃塞俄比亚南部公立医院接受颌面外科手术的成年患者中困难气道的发生率、相关因素以及气道检查的预测价值。
2022年3月至6月30日，在选定医院对250名颌面患者进行了一项基于机构的多中心横断面研究。数据录入Epi_Data软件4.3版，并使用STATA软件14版进行分析。在双变量分析中，所有P值小于0.25的具有统计学意义的变量都纳入多变量逻辑回归分析。通过受试者工作特征曲线分析气道检查在预测困难气道方面的预测价值或有效性。
在本研究中，困难气道的发生率为21.2%（95%可信区间=16.3-26.1%），困难插管、困难喉镜检查和困难面罩通气的发生率分别为6.4%（95%可信区间3.3-9.4%）、9.6%（95%可信区间6.1-13%）和13.6%（95%可信区间9.1-16.8%）。头颈外科手术史调整后的优势比（AOR）=6.3，95%可信区间（2.85-14.34）；颈托AOR=4.9，95%可信区间（1.96-12.49）；颈椎损伤AOR=2.4，95%可信区间（1.07-5.38），均与气道困难独立且显著相关。改良马兰帕蒂分级和颏胸距离被确定为预测困难喉镜检查、插管和面罩通气的良好术前检查。
困难气道在颌面外科手术中发生率较高。在各种气道评估检查中，没有单一检查是完全准确的。建议麻醉专业人员联合使用术前气道评估方法。
