Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients.
OBJECTIVE
Cardiac surgery patients might have a higher incidence of difficult laryngoscopy than the general population because of older age, dental problems, and obesity. The authors estimated the incidence and predictors of difficult laryngoscopy in coronary artery bypass surgery patients.


METHODS
Prospective, controlled study.


METHODS
University setting.


METHODS
Patients undergoing coronary artery bypass or general surgery.


METHODS
Two hundred consecutive patients undergoing coronary artery bypass graft and 444 general surgery patients, all aged >40 years, were compared for the incidence and predictors of difficult laryngoscopy, defined as a grade III or IV view.


RESULTS
Predictors of difficult laryngoscopy were considered mouth opening <4 cm, limited cervical mobility, thyromental distance <6 cm, protruding or partially missing upper teeth, and Mallampati classes 3 and 4. More cases of difficult laryngoscopy were recorded in cardiac patients (10% v 5.2%, p <0.023). The cardiac patients were older, mostly men, and belonged to ASA III-IV risk classes. Mallampati classes 3 and 4 were more frequent in the control group. With univariate analysis, difficult laryngoscopy correlated with 7 variables: older age, ASA-IV risk class, protruding or partially missing upper teeth, limited mouth opening, limited neck movement, thyromental distance <6 cm, and diabetes mellitus. Multivariate analysis adjusted for propensity score identified older age (odds ratio = 1.05/yr, 95% confidence interval = 1.005-1.09, p < 0.03) and limited neck movement (odds ratio = 9.5, 95% confidence interval = 2.2-41, p < 0.003), but not cardiac surgery per se, as independent predictors of difficult laryngoscopy.


CONCLUSIONS
Difficult laryngoscopy was more frequent in cardiac surgery patients (10% v 5.2%). Older age and limited neck movement, but not cardiac surgery per se, were independent predictors of difficult laryngoscopy.
Ezri
Tiberiu
T
Department of Anesthesia, Pediatric Cardiac Surgery Unit, Wolfson Medical Center, Holon, Tel-Aviv, Israel. tezri@netvision.net.il
Weisenberg
Marian
M
Khazin
Vadim
V
Zabeeda
Deeb
D
Sasson
Lior
L
Shachner
Arie
A
Medalion
Beniamin
B
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018849:Controlled Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007828:Laryngoscopy; D007830:Larynx / Q000033:anatomy & histology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology / Q000473:pathology; D015999:Multivariate Analysis; D009333:Neck / Q000033:anatomy & histology / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013223:Statistics as Topic; D014070:Tooth / Q000033:anatomy & histology / Q000473:pathology; D016896:Treatment Outcome