Predictors of difficulty in intubation in patients with obstructive sleep apnoea

Cybil Mei Zhi Wang; Kenny Peter Pang; Tan Soo Guan; Kathleen Ann Pang; Edward Benjamin Pang; Tan Yuk Ngi Cherilynn; Yiong Huak Chan; Brian W Rotenberg

Return

Predictors of difficulty in intubation in patients with obstructive sleep apnoea

Author: Cybil Mei Zhi Wang ¹ ; Kenny Peter Pang ¹ ; Tan Soo Guan ² ; Kathleen Ann Pang ¹ ; Edward Benjamin Pang ¹ ; Tan Yuk Ngi Cherilynn ¹ ; Yiong Huak Chan ³ ; Brian W. Rotenberg ⁴
Author Information

1. Department of Otolaryngology, Asia Sleep Centre, Singapore
2. Department of Anaesthesiology, Asia Sleep Centre, Singapore
3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore
4. Department of Otolaryngology, Head and Neck Surgery, Western University, London, Ontario, Canada
Publication Type:Journal Article
Keywords: Intubation; Sleep Apnoea; Anaesthesia Level of evidence: IV
From: The Medical Journal of Malaysia 2019;74(2):133-137
CountryMalaysia
Language:English
Abstract: Objective: To evaluate predictors of difficult intubation in patients with obstructive sleep apnoea (OSA). Methodology: Prospective series of 405 OSA patients (350 males/55 females) who had upper airway surgery. Procedures included functional endoscopic sinus surgery, septoplasty, turbinate reduction, palate/tonsil surgery, and/or tongue base surgery. Intubation difficulty (ID) was assessed using Mallampati grade, Laryngoscopic grade (Cormack and Lehane), and clinical parameters including BMI, neck circumference, thyromental distance, jaw adequacy, neck movements and glidescope grading. Results: Mean age was 41.6 years old; mean BMI 26.6; mean neck circumference 44.5cm; mean Apnea Hypopnea Index (AHI) was 25.0; and mean LSAT 82%. The various laryngeal grades (based on Cormack and Lehane), grade 1 - 53 patients (12.9%), grade 2A - 127 patients (31.0%), grade 2B - 125 patients (30.5%), grade 3 - 93 patients (22.7%) and grade 4 - seven patients (1.7%); hence, 24.4% had difficulties in intubation. Parameters that adversely affected intubation were, age of the patient, opening of mouth, retrognathia, overbite, overjet, limited neck extension, thyromental distance, Mallampati grade, and macroglossia (p<0.001). Body mass index (BMI) (p=0.087), neck circumference (p=0.645), neck aches (p=0.728), jaw aches (p=0.417), tonsil size (p=0.048), and AHI (p=0.047) had poor correlation with intubation. BMI-adjusted for Asians and Caucasians, showed that Asians were more likely to have difficulties in intubation (adjusted OR = 4.6 (95%Confidence Interval: 1.05 to 20.06) (p=0.043), compared to the Caucasian group.
Full text:6.2019.my1404.pdf