An Association of Predicted/Unpredicted Difficult Intubation with Fibreoptic Bronchoscopic Intubation

Abstract

Aim: Inadequate preoperative airway assessment is one of the most common causes of failed airway management and intubation. Fibreoptic bronchoscopic intubation (FBI) is an effective technique for creating airway access in patients with expected and unexpected difficult airways. The aim of this study is to evaluate the incidence of predicted difficult airway (DA) in patients intubated due to DA with FBI. Materials and Methods: We retrospectively reviewed the medical records of one hundred and forty-three ASA I-V patients aged 0-80 years diagnosed with DA who underwent flexible FBI from January 2006 to December 2011. Age, weight, sex, concomitant syndromes, whether difficult intubation (DI) occurred after trauma, whether FBI was applied via nasal or oral ways, size of tube, whether FBI was successful or not and relationships of these parameters were analysed. Results: The study involved 143 patients, 38 (22.2%) in the pediatric group and 105 patients (77.8%) in the adult group. Of the patients, 64 (47.4%) were female and 71 (52.6%) were male. 42 patients underwent DI for syndromes with craniofacial abnormalities. As a result of preoperative anaesthetic assessment, DI could be predicted in 74 patients (51.7%) by history, physical examination and Mallampati scoring, while unexpected DI occurred in 69 (48.3%) of patients. The proportion of predicted DA was much higher in children compared to adults. Conclusion: It is not easy to check all predictors of DI in a pre-anaesthetic examination and the predictors are not accurate. Unexpected DI is not a rare occurrence in the operating room (OR). Despite a thorough pre-operative assessment, anaesthetists may not be able to predict what they will encounter during surgery and therefore should always be prepared for any challenge. Keywords: Preoperative assessment, predicted difficult intubation, fiberoptik bronchoscopic intubation, syndromes with craniofacial abnormalities