title: Difficult intubation in the adult patients undergoing oropharygolaryngeal, neck, and maxillofacial procedures: Thai Anesthesia Incident Monitoring Study (Thai AIMS).
abstract: BACKGROUND
  Difficult intubation is one of the common anesthetic related complications during the perioperative period. In the patients with pathology or disease involving the oropharyngolarynx, neck, or maxillo-facial region, they might have a potentially higher risk than the general population.
  
  
  OBJECTIVE
  To determine the characteristics and the contributing factors of difficult intubation in the adult patients undergoing oropharyngolaryngeal, neck, and maxillofacial procedures, and the factors minimizing this incidence and the suggested corrective strategies.
  
  
  METHODS
  All incident reports of difficult intubation in the adult patients who received general anesthesia for the procedure involving the oropharyngolarynx, neck, and maxillofacial region from the Thai Anesthesia Incident Monitoring Study (Thai AIMS) database were identified. The details of the reports, the contributing factors, the factors those minimizing the incident, and the suggestive corrective strategies were studied.
  
  
  RESULTS
  There were 26 (1.3%) incident reports of difficult intubation from the database. This occurred in 35%, 58%, and 15% of the patients with Mallampati class 1-2, thyromental distance equal or more than 5 cm or 3 fingerbreadths, and combined both parameters, respectively. Forty two percent of cases were judged as an unplanned difficult intubation. Twenty-seven, 23, and 19 percent of the patients had tumor or carcinoma at the oropharyngolarynx, deep neck infection, and maxillofacial fracture, respectively. Nearly half of the adverse events accompanied with difficult intubation were desaturation. No immediate fatally and late outcome was reported. Patients' disease/anatomy was the major contributing factor that might relate to the incidence. Previous experience, experienced assistance, and high vigilance were the factors minimizing incidence. Suggestive corrective strategies were guideline practices, additional training, and improved supervision.
  
  
  CONCLUSIONS
  Carefully preoperative airway assessment and additional attention focused on the pathology or disease were the principle tasks. Algorithms for both anticipated and unanticipated difficult airway as well as alternative airway equipments should be implemented.
authors.affiliation: Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siapy@staff1.mahidol.ac.th
authors.forename: Annop
authors.initials: A
authors.lastname: Piriyapatsom
authors.forename: Tharnthip
authors.initials: T
authors.lastname: Pranootnarabhal
authors.forename: Ketchada
authors.initials: K
authors.lastname: Uerpairojkit
authors.forename: Yodying
authors.initials: Y
authors.lastname: Punjasawadwong
authors.forename: Sirilux
authors.initials: S
authors.lastname: Chumnanvej
authors.forename: Surasak
authors.initials: S
authors.lastname: Tanudsintum
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D006761:Hospitals; D006801:Humans; D007440:Intubation; D008991:Monitoring, Physiologic; D019647:Oral Surgical Procedures; D009960:Oropharynx / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D012308:Risk Management; D012449:Safety; D013785:Thailand